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Outcomes of resection for non-small cell lung cancer in octogenarians

Year 2015, Volume: 7 Issue: 3, 1 - 5, 01.12.2015

Abstract

Aim: In this study, factors that affect morbidity and mortality rates and surgery decision criteria for octogenarians age 80-89 according to WHO who underwent pulmonary resections because of non-small cell lung cancer, have been inquired. Methods: Clinical files of 38 octogenarians undergoing lung resection between 2007-2012 were reviewed retrospectively in our thoracic surgery department. Results: 36 94.7% male and 2 5.3% female patients were icluded to the study. Median age of 80 range 80- 88 . ASA score was 1 in 23 60.5% , 2 in 11 28.9% and 3 in 4 10.5 % . 16 patients had additonal diseases. The FEV1 value of each subject was above 2 liters. One patient underwent videothorascopic resection, while the rest was operated via conventional posterolateral thoracotomies. As a resection type; 28 lobectomies, 6 pneumonectomies, 3 bilobectomies and 1 sleeve lobectomy performed. 24 patients developed postoperative complications 63.2% , with prolonged air leak being the most frequent one 7.9% . Thirty -day mortality was 4 10.4% . Five year survival rate was found to be 44.7%, with mean survival time of 33 months. Conclusions: Age does not contraindicate cancer surgery for patients with conserved pulmonary reserve in octogenarians. In conclusion, the challenges involved in cancer surgery on such patients should be braved due to the marked increase in survival rate post surgery.

References

  • Miguel G, Paulo N, Jose M. Surgical Treatment of non-small cell lung cancer in octogenerians. Interact.Cardiovascular and Thoracic Surgery 2013;16: 673-680.
  • Onder G,D’arco C,Fusco D,Bernaber R. Preopar- tive assesment and risc factors in the surgical treatment of lung cancer: the role of age. Rays 2004; 29: 407-411.
  • Nugent WC,Edney MT,Hammernes PG,Dain BJ,Maurer LH.Rigas JR. Non small cell lung can- cer at the extremes of age;impact on diagnosis and treatment. Ann Thoracic Surg 1997;63:193- 197.
  • Andrea D,Marco M,Nicola M,Stefano S,Guido C,Franco S,Davide D,Gaetano R. Early long-term results of pulmonary resection for non-small cell lung cancer in patients over 75 years of age:a multi-institutional study. Interact.Cardiovascular and Thoracic Surgery 2013;16(3):250-256.
  • Janssen F, Kunst Aj, The choice among past trends as a basis for the prediction of future trends in older age mortality. Popul Stud (Camb) 2007; 61:315-326.
  • Brock MV, Kim MP, Hooker CM, Alberg AJ, Jordan MM, Roig CM et al. Pulmonary resection in oc- togenarians with stage I non-small cell cancer:a 22 year experience. Ann Thorac Surg 2004;77: 271-277.
  • Chaisit S, Kiyoshi K, Shuji H, Iwao M, Yoshihito I,Kazuo S. Thorascopic surgery for non-small-cell lıng canser: elderly vs. octogenarians. Asian car- diovascular & thoracic annals 2013; 21(1):56-60.
  • Fanucci O, Ambrogi MC, Dini P, Melfi F, Davini F. Et al.Surgical treatment of non-small cell lung cancer in octogenarians. Interact Cardiovasculer Surg 2011;12: 749-753.
  • Okami J, Higashiyima M, Asamura H, Goya T, Ko- shiishi Y, Sohata Y et al, for the Japanese Joint Committee of lung canser Registry.Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer. Tho- racic oncol 2009;4:1247-1253.
  • E. Okur, H. Okur, M. Gökçe, V. Baysungur, A. Kır, S. Halezaroğlu, A. Atasalihi. Akciğer Kanseri Nedeniyle Rezeksiyon Uygulanan 70 Yaş ve Üze- rindeki Olgularımızın Analizi. Toraks Derneği 7. Yıllık Kongresi Mini Sempozyum
  • Brunelli A, Socci L, Refai M, Salati M, Xiumé F, Sabbatini A.Quality of life before and after ma- jor lung resection for lung cancer: a prospec- tive follow-up analysis. Ann Thorac Surg. 2007; 84(2):410-416.
  • Harpole DH Jr,Decamp MM Jr,Hur K,OPrian CA,Henderson WG et al.Prognostic models of thirty day,mortality and modbidity after major pulmonary resection.J Thoracic Cardiovasc Surg 1999;117:969-979.
  • Boffa DJ,Affen MS,Grab JD,Gaissert HA,Harpole DH,Wright CD.Data from The Society of Thoracic Surgeons General Thoracic Surgery data base the surgical management of primary lung tumors.J Thorac Cardiovasc.Surgery 2008;135:247-254.
  • David J.C. and G.Alec Rooke. Priorities in Periop- erative Geriatrics.Anesth Analg. 2003; 96:1823- 1836.
  • Franklin SS, Gustin WT, Wong ND, et al. Hemod- ynamic patterns of age-related changes in blood pressure: the Framingham Heart Study. Circula- tion 1997;96: 308-315.
  • Landahl S, Bengtsson C, Sigurdsson JA, et al. Age-related changes in blood pressure. Hyper- tension 1986;8:1044-1449.
  • Pan HY, Hoffman BB, Pershe RA, Blaschke TF. De- cline in beta adrenergic receptor-mediated vas- cular relaxation with aging in man. J Pharmacol Exp Ther 1986;239:802-807.
  • Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesthesiol Clin North Am 2000;18: 47–58.
  • Fowler RW. Ageing and lung function. Age Age- ing 1985;14: 209–215.
  • Hankinson JL, Odencrantz JR, Fedan KB. Spiro- metric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159:179 –187.
  • Cane ME, Chen C, Bailey BM, Fernandez J, Laub GW, Anderson WA, et al.CABG in octogenari- ans: early and late events and actuarial survival in comparison with a matched population.Ann Thoracic Surg 1995;60:1033-1037.
  • Miller M.Fluid and electrolyte balance in elderly. Geriatrics 1987; 42(11):65-8, 71, 75-76.

Oktogenaryanlarda küçük hücreli dışı akciğer kanseri nedeniyle yapılan rezeksiyonların sonuçları

Year 2015, Volume: 7 Issue: 3, 1 - 5, 01.12.2015

Abstract

Amaç: Bu çalışmada, hastanemizde son beş yılda Küçük Hücreli Dışı Akciğer kanseri KHDAK nedeniyle rezeksiyon yaptığımız oktogenaryanlarda DSÖ'ne göre;80-89 yaş aralığı morbidite ve mortalite oranlarını etkileyen ve cerrahi için karar vermede önemli olan kriterler araştırıldı. Gereç ve Yöntem: 2007-2012 yılları arasında göğüs cerrahi kliniğimizde akciğer rezeksiyonu yapılan seksen ve üstü yaştaki 38 olgunun klinik dosyaları retrospektif olarak incelendi. Bulgular: Olguların 36'sı % 94.7 erkek, sadece 2'si %5.3 kadındı. Yaş aralığı 80-88 ortalama 80.68 idi. ASA skoru; ASA1 23 %60.5 , ASA2 11 %28.9 ve ASA 3 4 %10.5 olguydu. 16 olgumuzda ek hastalık özellikle hipertansiyon çoğunlukta olmak üzere mevcuttu. Tüm olguların FEV1 değerleri 2 litrenin üzerindeydi. VATS ile akciğer rezeksiyonu uygulanan 1 olgu hariç diğer 37 olguya torakotomiyle rezeksiyon yapıldı. Rezeksiyon tipleri; 8 sağ üst, 8 sol üst, 7 sağ alt, 4 sol alt lobektomi, 6 pnömonektomi, 3 bilobektomi ve 1 “sleeve” lobektomiydi. Histopatolojik tanı olarak; 24 % 63.2 skuamöz karsinoma, adeno 11 % 28.9 , pleomorfik 1 % 2.6 , bronkoalveolar 1 % 2.6 , büyük hücreli karsinoma 1 2.6% . En sık postoperatif evreler, IB %31.6 12 olgu, IA %26.3 10 olgu, IIA %15.8 6 olgu, IIB ve IIIA %13.2 5'er olguydu. Postoperatif komplikasyon 24 olguda gelişti % 63.2 ve bunların içinde en çok gördüğümüz pulmoner komplikasyon uzamış hava kaçağıydı. 7.9% .Postoperatif 30 gün içinde 4 %10.4 olgumuz eks oldu. 5 yıllık sağkalım oranımız %44.7 olarak hesaplandı. Ortalama yaşam postoperatif 33 ay olarak bulundu. Sonuçlar: KHDAK nedeniyle akciğer rezeksiyonu yapılan oktogenaryanlarda, postoperatif komplikasyon riski, hastanede kalış süresi, morbidite ve mortalite oranı yüksek olmakla birlikte, pulmoner rezervi korunmuş olgularda yaş, cerrahi için kontrendikasyon değildir. Oktogenaryanlarda kanser cerrahisinde, cerrahinin eğer 5 yıllık sağkalıma gözle görünür katkısı varsa, tüm bu sorunlar cesurca göğüslenmelidir.

References

  • Miguel G, Paulo N, Jose M. Surgical Treatment of non-small cell lung cancer in octogenerians. Interact.Cardiovascular and Thoracic Surgery 2013;16: 673-680.
  • Onder G,D’arco C,Fusco D,Bernaber R. Preopar- tive assesment and risc factors in the surgical treatment of lung cancer: the role of age. Rays 2004; 29: 407-411.
  • Nugent WC,Edney MT,Hammernes PG,Dain BJ,Maurer LH.Rigas JR. Non small cell lung can- cer at the extremes of age;impact on diagnosis and treatment. Ann Thoracic Surg 1997;63:193- 197.
  • Andrea D,Marco M,Nicola M,Stefano S,Guido C,Franco S,Davide D,Gaetano R. Early long-term results of pulmonary resection for non-small cell lung cancer in patients over 75 years of age:a multi-institutional study. Interact.Cardiovascular and Thoracic Surgery 2013;16(3):250-256.
  • Janssen F, Kunst Aj, The choice among past trends as a basis for the prediction of future trends in older age mortality. Popul Stud (Camb) 2007; 61:315-326.
  • Brock MV, Kim MP, Hooker CM, Alberg AJ, Jordan MM, Roig CM et al. Pulmonary resection in oc- togenarians with stage I non-small cell cancer:a 22 year experience. Ann Thorac Surg 2004;77: 271-277.
  • Chaisit S, Kiyoshi K, Shuji H, Iwao M, Yoshihito I,Kazuo S. Thorascopic surgery for non-small-cell lıng canser: elderly vs. octogenarians. Asian car- diovascular & thoracic annals 2013; 21(1):56-60.
  • Fanucci O, Ambrogi MC, Dini P, Melfi F, Davini F. Et al.Surgical treatment of non-small cell lung cancer in octogenarians. Interact Cardiovasculer Surg 2011;12: 749-753.
  • Okami J, Higashiyima M, Asamura H, Goya T, Ko- shiishi Y, Sohata Y et al, for the Japanese Joint Committee of lung canser Registry.Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer. Tho- racic oncol 2009;4:1247-1253.
  • E. Okur, H. Okur, M. Gökçe, V. Baysungur, A. Kır, S. Halezaroğlu, A. Atasalihi. Akciğer Kanseri Nedeniyle Rezeksiyon Uygulanan 70 Yaş ve Üze- rindeki Olgularımızın Analizi. Toraks Derneği 7. Yıllık Kongresi Mini Sempozyum
  • Brunelli A, Socci L, Refai M, Salati M, Xiumé F, Sabbatini A.Quality of life before and after ma- jor lung resection for lung cancer: a prospec- tive follow-up analysis. Ann Thorac Surg. 2007; 84(2):410-416.
  • Harpole DH Jr,Decamp MM Jr,Hur K,OPrian CA,Henderson WG et al.Prognostic models of thirty day,mortality and modbidity after major pulmonary resection.J Thoracic Cardiovasc Surg 1999;117:969-979.
  • Boffa DJ,Affen MS,Grab JD,Gaissert HA,Harpole DH,Wright CD.Data from The Society of Thoracic Surgeons General Thoracic Surgery data base the surgical management of primary lung tumors.J Thorac Cardiovasc.Surgery 2008;135:247-254.
  • David J.C. and G.Alec Rooke. Priorities in Periop- erative Geriatrics.Anesth Analg. 2003; 96:1823- 1836.
  • Franklin SS, Gustin WT, Wong ND, et al. Hemod- ynamic patterns of age-related changes in blood pressure: the Framingham Heart Study. Circula- tion 1997;96: 308-315.
  • Landahl S, Bengtsson C, Sigurdsson JA, et al. Age-related changes in blood pressure. Hyper- tension 1986;8:1044-1449.
  • Pan HY, Hoffman BB, Pershe RA, Blaschke TF. De- cline in beta adrenergic receptor-mediated vas- cular relaxation with aging in man. J Pharmacol Exp Ther 1986;239:802-807.
  • Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesthesiol Clin North Am 2000;18: 47–58.
  • Fowler RW. Ageing and lung function. Age Age- ing 1985;14: 209–215.
  • Hankinson JL, Odencrantz JR, Fedan KB. Spiro- metric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159:179 –187.
  • Cane ME, Chen C, Bailey BM, Fernandez J, Laub GW, Anderson WA, et al.CABG in octogenari- ans: early and late events and actuarial survival in comparison with a matched population.Ann Thoracic Surg 1995;60:1033-1037.
  • Miller M.Fluid and electrolyte balance in elderly. Geriatrics 1987; 42(11):65-8, 71, 75-76.
There are 22 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Aysun Kosif Mısırlıoğlu This is me

Serda Kanbur Metin This is me

Meltem Çoban Ağca This is me

Rıza Serdar Evman This is me

İlhan Ocakcıoğlu This is me

Levent Alpay This is me

Deniz Gürer This is me

Sibel Arınç This is me

Selami Volkan Baysungur This is me

İrfan Yalçınkaya This is me

Publication Date December 1, 2015
Published in Issue Year 2015 Volume: 7 Issue: 3

Cite

Vancouver Mısırlıoğlu AK, Metin SK, Ağca MÇ, Evman RS, Ocakcıoğlu İ, Alpay L, Gürer D, Arınç S, Baysungur SV, Yalçınkaya İ. Oktogenaryanlarda küçük hücreli dışı akciğer kanseri nedeniyle yapılan rezeksiyonların sonuçları. Maltepe tıp derg. 2015;7(3):1-5.