Lobectomy and pneumonectomy in patients over 70 years of age for the treatment of lung cancer: evaluation of surgical outcomes

Abstract

Aims: The primary aim of this study is to evaluate the surgical outcomes of lobectomy and pneumonectomy operations performed due to lung cancer in individuals aged 70 and above, and to analyze the factors influencing these outcomes. Methods: This retrospective study covers lobectomy and pneumonectomy operations performed on 103 lung cancer patients over the age of 70, from January 2018 to December 2021. A dataset was created including patients’ demographic information, smoking status, comorbidities, results of pulmonary function tests and echocardiography, preoperative complete blood count, and serum albumin levels, and these data were analyzed. Results: The average age of the patients was 73.3; 83.5% were male, and 16.5% were female. The complication rate was 47.6%, and the 30-day surgical mortality rate was 8.7%. Patients with a high American Society of Anesthesiologists (ASA) score had higher rates of complications and mortality (p=0.015). Low preoperative serum albumin (p=0.017) and hemoglobin (p=0.026) levels were associated with an increased risk of complications. Postoperative outcomes between Video Assisted Thoracoscopic Surgery (VATS) and thoracotomy were found to be similar. Conclusion: The study demonstrates that in elderly lung cancer surgery, comorbidities and preoperative nutritional status are decisive factors affecting surgical outcomes. Preoperative albumin and hemoglobin levels emerge as significant indicators in assessing the risk of postoperative complications. VATS and thoracotomy are surgical techniques with similar safety and efficacy profiles.

Keywords

• Lung cancer
• elderly
• lobectomy
• pneumonectomy

References

1. Elfrink AKE, Alberga AJ, van Berge Henegouwen MI, et al. Outcomes after major surgical procedures in octogenarians: a nationwide cohort study. World J Surg. 2022;46(10):2399-2408.
2. Neuwirth MG, Bierema C, Sinnamon AJ, et al. Trends in major upper abdominal surgery for cancer in octogenarians: has there been a change in patient selection? Cancer. 2018;124(1):125-135.
3. Ni L, Lin G, Zhang Z, Sun D, Liu Z, Liu X. Surgery versus radiotherapy in octogenarians with stage Ia non-small cell lung cancer: propensity score matching analysis of the SEER database. BMC Pulm Med. 2022;22(1):411.
4. Bei Y, Chen X, Raturi VP, Liu K. Treatment patterns and outcomes change in early-stage non-small cell lung cancer in octogenarians and older: a SEER database analysis. Aging Clin Exp Res. 2021;33(1):147-156.
5. Damhuis RA, Senan S, Khakwani A, Harden S. Age-related treatment patterns for stage I NSCLC in three European countries. J Geriat Oncol. 2021;12(8):1214-1219.
6. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008;135(2):247-254.
7. Falcoz PE, Conti M, Brouchet L, et al. The Thoracic Surgery Scoring System (Thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. J Thorac Cardiovasc Surg. 2007;133(2):325-332.
8. Hino H, Murakawa T, Ichinose J, et al. Results of lung cancer surgery for octogenarians. Ann Thorac Cardiovasc Surg. 2015;21(3):209-216.

9. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg. 2006;81(5):1830-1837.
10. Shao J, Li J, Zhang XL, Wang G. Prognostic significance of the preoperative controlled nutritional status score in lung cancer patients undergoing surgical resection. Nutr Cancer. 2021;73(11-12):2211-2218.
11. Wei S, Shao J, Wang J, Wang G. The preoperative hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for non-small cell lung cancer patients undergoing adjuvant chemotherapy: a retrospective study. Ann Transl Med. 2022;10(8):457.
12. Ogawa H, Fujibayashi Y, Nishikubo M, et al. Prognostic significance of preoperative haemoglobin A1c level in patients with lung adenocarcinoma. Interact Cardiovasc Thorac Surg. 2021;33(4):534-540.
13. Taylor M, Abah U, Hayes T, et al. Preoperative anemia is associated with worse long-term survival after lung cancer resection: a multicenter cohort study of 5,029 patients. J Cardiothorac Vasc Anesth. 2022;36(5):1373-1379.
14. Aoki T, Tsuchida M, Watanabe T, et al. Surgical strategy for clinical stage I non-small cell lung cancer in octogenarians. Eur J Cardiothorac Surg. 2003;23(4):446-450.
15. Okami J, Higashiyama M, Asamura H, et al. Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer: prognostic factors for overall survival and risk factors for postoperative complications. J Thorac Oncol. 2009; 4(10):1247-1253.
16. Ito H, Nakayama H, Yamada K, Yokose T, Masuda M. Outcomes of lobectomy in ‘active’ octogenarians with clinical stage I non-small-cell lung cancer. Ann Thorac Cardiovasc Surg. 2015;21(1):24-30.
17. Saftic I, Bille A, Asemota N, et al. Risks and rewards of the surgical treatment of lung cancer in octogenarians. Interact Cardiovasc Thorac Surg. 2021;33(6):905-912.
18. Kutluk AC, Akin H, Ceritoglu A, et al. Is the outcome of pulmonary resections due to non-small cell lung cancer in octogenarian patients worse? Ann Thorac Cardiovasc Surg. 2019; 25(2):95-101.
19. Dominguez-Ventura A, Allen MS, Cassivi SD, Nichols III FC, Deschamps C, Pairolero PC. Lung cancer in octogenarians: factors affecting morbidity and mortality after pulmonary resection. Ann Thorac Surg. 2006;82(4):1175-1179.
20. Pagès PB, Mariet AS, Madelaine L, et al. Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians. J Thorac Cardiovasc Surg. 2019; 157(4):1660-1667.