A retrospective review of patients over 70 years of age undergoing pneumonectomy for non-small cell lung cancer: 10 years of experience, a cross-sectional study

Yıl 2020, , 351 - 354, 01.05.2020

Ozgur Omer Yildiz , Kubilay İnan İlknur Aytekin Çelik , Eray Çınar

https://doi.org/10.28982/josam.727381

Öz

Aim: Future projections suggest that more older people will be affected by non-small cell lung cancer (NSCLC) over the next years due to longer life expectancy and aging global population. Chronological age is used to define elderly. 70 years of age is the most commonly accepted lower limit of senescence since the majority of physiological changes occur after this age. The aim of the current study was to review demographic, epidemiological and clinical characteristics of patients over the age of 70 diagnosed with NSCLC who underwent pneumonectomy at our clinic in a retrospective manner.
Methods: This cross-sectional study involved a retrospective assessment of 21 patients over 70 years of age who were diagnosed with NSCLC and underwent pneumonectomy between January 2010 and January 2020. Demographic data, symptoms, tumor types, localization of tumors, postoperative complications and stages of cancer were recorded in the database and statistically analyzed.
Results: All 21 patients were male and had a mean age of 72.5 years. The presenting symptom was dyspnea in 23.8% of the patients, cough in 28.6%, hemoptysis in 19%, chest pain in 14.3% and weight loss in 4.8% of the patients and 9.5% of the cases were detected incidentally. The tumor types included squamous cell carcinoma (57.1%), adenocarcinoma (23.8%), adenosquamous carcinoma (14.3%) and large cell carcinoma (4.8%). Tumor site was the left lung in 81% and right lung in 19% of the patients. Early postoperative complications occurred in 5 (23.8%) patients. Three of these patients developed atrial fibrillation and two patients suffered hemorrhage. Postoperative tumor stages of the patients were stage 3a (47.6%), stage 2b (19%), stage 2a (14.3%), stage 1b (9.5%) and stage 1a2 (9.5%). Multidimensional scaling analysis showed an association between the type of tumor and smoking but no association was found between tumor type and family history (P=0.024, P=0.586, respectively).
Conclusion: It should be kept in mind that surgical resection and even pneumonectomy which is associated with high mortality and morbidity can be successfully performed in older cancer patients through a good preoperative workup, tumor staging, assessment of the risk of mortality and the effects of comorbid conditions. 

Anahtar Kelimeler

Lung cancer, Surgery, Pneumonectomy, Age

Küçük hücreli dışı akciğer kanseri nedeniyle pnömonektomi uygulanan 70 yaş üzerindeki hastaların incelemesi: 10 yıllık deneyim, kesitsel çalışma

Öz

Amaç: Uzayan yaşam süresi ve yaşlanan dünya nüfusu ilerleyen yıllarda daha fazla sayıda yaşlı küçük hücreli dışı akciğer kanserli (KHDAK) hastanın ortaya çıkacağını göstermektedir. Yaşlılık tanımlaması için kronolojik yaş kullanılmaktadır. 70 yaş fizyolojik değişikliklerin giderek artmaya başladığı dönem olması nedeniyle en çok kabul gören sınır olmuştur. Çalışmamızda; kliniğimizde KHDAK tanısı nedeniyle pnömonektomi uygulanmış 70 yaş üstü hastaların demografik, epidemiyolojik ve klinik özelliklerinin geriye dönük olarak incelenmesi amaçlanmıştır.
Yöntemler: Kesitsel tipteki bu çalışmada, Ocak 2010 ile Ocak 2020 arasında KHDAK tanısı alan ve pnömonektomi yapılan 70 yaş üstü 21 hastanın retrospektif olarak değerlendirilmesi yapıldı. Demografik veriler, semptomlar, tümör tipleri, tümörlerin lokalizasyonu, postoperatif komplikasyonlar ve kanser evreleri veri tabanına kaydedildi ve istatistiksel olarak analiz edildi.
Bulgular: Çalışmamızda yer alan 21 hastanın tamamı erkek ve ortalama yaş 72,5 idi. Hastaların %23, 8’i dispne, %28,6’ı öksürük, %19’u hemoptizi, %14,3’ü göğüs ağrısı, %4,8’i kilo kaybı şikayeti ile başvururken %9,5’i insidental olarak saptanmıştır. Tümör tipi %57,1 squamöz hücreli karsinom, %23,8 adenokarsinom, %14,3 adenosquamöz karsinom ve %4,8 large cell karsinom olarak tespit edilmiştir. Tümör %81 sol, %19 sağ akciğer yerleşimliydi. Postoperatif erken dönemde olguların 5’inde (%23,8) komplikasyon görülmüştür. Erken dönem komplikasyon görülen olguların 3’ünde atrial fibrilasyon, 2’sinde kanama olduğu görüldü. Hastaların postoperatif evreleri; %47,6’ı evre 3a, %19’u evre 2b, %14,3’ü evre 2a, %9,5’i evre 1b ve %9,5’i evre 1a2 idi. Çok boyutlu ölçekleme analizinde tümör tipi ile sigara kullanımının ilişkisi saptanmış ancak aile öyküsü ile tümör tipi arasında ilişki kurulamamıştır (sırasıyla P=0.024, P=0.586).
Sonuç: Cerrahi rezeksiyon olarak morbidite ve mortalitesi yüksek olan pnömonektominin bile yaşlı hastalarda iyi bir preoperatif değerlendirme, evreleme, eşlik eden hastalıkların etkileri ve mortalite tayini ile başarılı bir şekilde uygulanabileceği bilinmelidir.

Anahtar Kelimeler

Akciğer kanseri, Cerrahi, Pnömonektomi, Yaş

Kaynakça

• 1. Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24:4539-44.
• 2. Cicero JL, Ponn RB, Daly DT. Surgical Treatment of non-small cell lung cancer. In: Shields TW, Cicero JL, Ponn RB, Valerie RW, editors. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. pp. 1548-81.
• 3. Ishida T, Yokoyama H, Kaneko S, Sugio K, Sugimachi K. Long-term results of operation for non-small cell lung cancer in the elderly. Ann Thorac Surg. 1990;50:919-22.
• 4. Pagni S, McKelvey A, Riordan C, Federico JA, Ponn RB. Pulmonary resection for malignancy in the elderly: is age still a risk factor? Eur J Cardiothorac Surg. 1998;14:40-4.
• 5. Balducci L. Geriatric oncology: challenges for the new century. Eur J Cancer. 2000;36:1741-54.
• 6. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061-7.
• 7. Fentiman IS, Tireli U, Monfardini S, Schneider M, Festen J, Cognetti F, et al. Cancer in the elderly: why so badly treated? The Lancet. 1990;335:1020-2.
• 8. Fossella FV, Belani CP. Phase III study (TAX 326) of docetaxel-cisplatin and docetaxel-carboplatin versus vinorelbine-cisplatin for the first line treatment of advanced/metastatic non-small cell lung cancer: analyses in elderly patients. Proc Am Soc Clin Oncol. 2003;22:629-30.
• 9. Lilenbaum RC, Herndon JE 2nd, List MA, Desch C, Watson DM, Miller AA, et al. Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730). J Clin Oncol. 2005;23:190-6.
• 10. Venuta F, Diso D, Onorati I, Anile M, Mantovani S, Rendina EA. Lung cancer in elderly patients. J Thorac Dis. 2016;8:908-14
• 11. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery---executive summary a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation. 2002;105:1257-67.
• 12. Goksel T. Bronş Karsinomu ve Soliter Pulmoner Nodül. In: Arseven O, ed. Temel Akciğer Sağlığı Hastalıkları. Istanbul. Nobel Tıp; 2011. pp 207-16.
• 13. Sigel K, Bonomi M, Packer S, Wisnivesky J. Effect of age on survival of clinical stage I non-small-cell lung cancer. Ann Surg Oncol. 2009;16:1912-7
• 14. Spaggiari L, Scanagatta P. Surgery of non-small cell lung cancer in the elderly. Curr Opin Oncol. 2007;19:84-91.
• 15. Matsuoka H, Okada M, Sakamoto T, Tsubota N. Complications and outcomes after pulmonary resection for cancer in patients 80 to 89 years of age. Eur J Cardiothorac Surg. 2005;28:380-3
• 16. Cerfolio RJ, Bryant AS. Survival and outcomes of pulmonary resection for non small cell lung cancer in the elderly: a nested case-control study. Ann Thorac Surg. 2006;82:424-9.
• 17. Yazgan S, Gürsoy S, Yaldiz S, Basok O. Outcome of surgery for lung cancer in young and elderly patients. Surg Today. 2005;35:823-7.
• 18. Sirbu H, Schreiner W, Dalichau H, Busch T. Surgery for nonsmall cell carcinoma in geriatric patients: 15-year experience. Asian Cardiovasc Thorac Ann. 2005;13:330-6.
• 19. Aslan F , Demirci U , Kizilgoz D , Yildiz F , Akin Kabalak P , Bugdayci Basal F et al. Prognostic factors affecting survival in third-line treatment of advanced non-small cell lung cancer: Retrospective cohort study. J Surg Med. 2020;4:135-8.
• 20. Melek H, Medetoglu B, Demir A, Kara V, Dincer IS. Mortality and morbidity after surgical treatment in elderly patients with non-small cell lung cancer: the role of age. Turkish J Thorac Cardiovasc Surg. 2011;19:586-9.
• 21. Ponn RB, Complications of pulmonary resection. In: Shields TW, Cicero JL, Ponn RB, Valerie RW, editors. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. pp. 558-86.
• 22. Voltolini L, Rapicetta C, Ligabue T, Luzzi L, Scala V, Gotti G. Short- and long-term results of lung resection for cancer in octogenarians. Asian Cardiovasc Thorac Ann. 2009;17:147-52.
• 23. Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations. J Thorac Cardiovasc Surg. 1993;106:1104-10.
• 24. Toker A, Solak O, Günlüoğlu Z, Kocatürk C, Dinçer İ, Kullep M ve ark. Yaşlı hastalarda akciğer kanseri cerrahi tedavisi. Solunum. 2001;3:9-13.
• 25. Bravo-Iñiguez C, Perez Martinez M, Armstrong KW, Jaklitsch MT. Surgical resection of lung cancer in the elderly. Thorac Surg Clin. 2014;24:371-81.
• 26. O’Rourke MA, Feussner JR, Feigl P, Laszlo J. Age trends of lung cancer stage at diagnosis. Implications for lung cancer screening in the elderly. JAMA. 1987;258:921-6.
• 27. Mery CM, Pappas AN, Bueno R, Colson YL, Linden P, Sugarbaker DJ, et al. Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest. 2005;128:237-45.
• 28. Aelony Y. Lung Resection in the Elderly. Chest. 2006;129:496-7.