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Cardiothoracic Surgery |

VATS Lobectomy May Be a Preferable Approach to Lung Resection in Patients Over 80

Chad Hall*, BS; Rudy Lackner, MD; Karin Trujillo, MD
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University of Nebraska Medical Center, Omaha, NE


Chest. 2012;142(4_MeetingAbstracts):69A. doi:10.1378/chest.1389386
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Abstract

SESSION TYPE: Thoracic Surgery Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Non-small cell lung cancer (NSCLC) is a disease of the elderly, but many patients over 80 are not considered surgical candidates based on age and underlying co-morbidities. Patients may choose alternative management options such as chemotherapy with radiation or palliative care. These patients may benefit from operations such as a VATS lung resection or a traditional thoracotomy. This report describes our experience with minimally invasive and open lung resections in octogenarians for NSCLC.

METHODS: A retrospective chart review was performed on 35 patients over 80 years old who underwent a VATS or open lobectomy or segmentectomy for NSCLC since 2002. Patients were evaluated by age, tumor stage, length of stay and complication rates. Operations performed were: right upper lobectomy-17, right middle lobectomy-1, right lower lobectomy-7, left upper lobectomy-4, left lower lobectomy-6, RLL superior segmentectomy-1.

RESULTS: Mean age was 83.2±2.5 (range 80-90). Out of 35 patients, 17 underwent a VATS procedure and 18 underwent an open procedure. Average length of stay was 9.9±9.3 (range 3-47). There were 4 total operative mortalities (11.4%), 3 underwent an open procedure. No complications occurred in 7/30 (23%) patients. Complications included atrial fibrillation-10; prolonged airleaks-3; urinary retention-2; pneumonia-2; subcutaneous emphysema-1; cerebral vascular accident-1; ARDS-1; PE-1; atelectasis-1. Stages included: IA-4; IB-15; IIB-4; IIIA-10.

CONCLUSIONS: Octogenarians with stage I-III NSCLC may benefit from minimally invasive or open lung resections. These operations were associated with minor complications, including atrial fibrillation, prolonged air leaks, urinary retention and pneumonia. Serious complications included ARDS and death. Post-operative length of stay is highly variable and dependent on the type of operation and post-operative complications.

CLINICAL IMPLICATIONS: Patients over 80 with resectable NSCLC may benefit from a VATS lobectomy over an open procedure based on operative complications and length of stay.

DISCLOSURE: The following authors have nothing to disclose: Chad Hall, Rudy Lackner, Karin Trujillo

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University of Nebraska Medical Center, Omaha, NE

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