Mortality and morbidity after surgical treatment in elderly patients with non-small cell lung cancer: the role of age

Melek H., Medetoglu B., DEMİR A., Kara V., Dincer S. I.



Background: This study aims to investigate the effect of age on mortality and morbidity after surgery performed during early stages in patients with non-small cell lung cancer (NSCLC). Methods: Two hundred thirty-seven patients referred to our clinic for surgical treatment with the diagnosis of NSCLC between November 2004 and January 2007 were retrospectively analyzed. All patients had been evaluated with respiratory function tests, a complete blood count, biochemistry, arterial blood gases and an electrocardiogram in the preoperative period. The patients over 70 years of age had also been evaluated by echocardiography. A mediastinoscopy was performed in all patients eligible for surgical treatment. A lung resection and lymphatic dissection through thoracotomy was performed on patients who had no lymph node metastasis at mediastinoscopy, or they received neoadjuvant oncological therapy. One hundred sixty-four patients (18 females, 146 males; mean age 59 years; range 30 to 84 years) who underwent a lung resection comprised our study group. Air leaks through a chest drain lasting more than 10 days, deaths within the 30-day postoperative period, and patients who were 70 years old and older were accepted as "persistent air leak", surgical mortality, and elderly patients, respectively. One hundred thirty-nine patients below 70 years of age and 25 patients over 70 years of age were grouped and compared for Morbidity and mortality rates. Results: Twenty-eight (20%) patients in group 1 and in five (20%) patients in group 2 had a history of chronic disease. A lobectomy and pneumonectomy was performed on 114 (82%) patients and on 25 (18%) patients in group 1, respectively. A lobectomy and pneumonectomy was performed on 20 (80%) and five (20%) patients of group 2, respectively. While there was one (0.7%) mortality in group 1, no mortality was observed in group 2. Morbidity was observed in 42 (30%) patients in group 1 and eight (32%) patients in group 2. The most frequent morbidities were persistent air leak, atelectasis, and arrhythmia. Conclusion: There was no significant increase in mortality and morbidity rates of patients with NSCLC who were over 70 years old. Surgery is safe and should be the treatment of choice in selected suitable patients in this age group.