Eastern Cardiothoracic Surgical Society

Safety and Feasibility of Thoracoscopic Lung Resection for Non-Small Cell Lung Cancer in Octogenarians
Xiaoying Lou, Andrew Sanders, Manu Sancheti, Jeffrey Javidfar, Allan Pickens, Seth Force, Felix Fernandez, Onkar Khullar, Emory University, Atlanta, GA, USA


OBJECTIVE: Octogenarians comprise an increasing proportion of patients presenting with non-small cell lung cancer (NSCLC). This study examines post-operative morbidity and mortality, and long term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC, compared with a younger cohort.

METHODS: We conducted a retrospective review of our institutional Society of Thoracic Surgeons-General Thoracic Surgery Database of all patients >60 years old undergoing elective lobectomy or segmentectomy for pathologic stage I or II NSCLC between 2009-2018. Results were compared between patients aged 60-79 (n=668) and 80-89 (n=71). Long-term survival among octogenarians was further assessed using Kaplan-Meier analysis.

RESULTS: The mean age of each cohort was 82.6 2.5 and 69.1 5.1 years. There were no significant differences in baseline co-morbidities, although the younger cohort was more likely to have T3/T4 cancer (p=0.01). Post-operative length of stay was not significantly different. However, a greater proportion of octogenarians required intensive care unit admission and discharge to extended care facilities. Among post-operative complications, only renal failure was more likely in the older cohort (Table 1). While in-hospital mortality was equivalent in both groups, thirty-day mortality was significantly higher among octogenarians (5.6% versus 1.5%, p=0.04). Overall survival among octogenarians at 1, 3, and 5 years were 86.8%, 50.3%, and 37.8%, respectively (Figure 1). On univariate analysis of baseline demographic variables, only the presence of coronary artery disease was a significant predictor of mortality (HR 2.98).

CONCLUSIONS: In a carefully selected cohort of octogenarians, thoracoscopic anatomic resection can be performed with favorable early post-operative outcomes. The factors impacting long-term survival warrant further investigation.

Table 1 – Comparison of Post-operative Outcomes after
Thoracoscopic Anatomic Lung Resection

Table 1 – Comparison of Post-operative Outcomes after

Thoracoscopic Anatomic Lung Resection

Variable ALL 60-79 yr old >80 yr old p-value
Pneumonia 3.8% (28/733) 4.0% (27/668) 1.5% (1/65) 0.50
Respiratory failure 2.6% (19/732) 2.7% (18/668) 1.6% (1/64) 0.72
Myocardial infarction 0.1% (1/734) 0.1% (1/668) 0.0% (0/66) 1.00
Stroke 0.1% (1/734) 0.0% (0/668) 1.5% (1/66) 0.09
Renal failure 1.4% (10/733) 0.9% (6/668) 6.2% (4/65) 0.01
Required ICU stay 9.8% (72/737) 9.0% (60/667) 17.1% (12/70) 0.03
In-hospital mortality 1.4% (10/739) 1.0% (7/668) 4.2% (3/71) 0.06
30-day mortality 1.9% (14/736) 1.5% (10/665) 5.6% (4/71) 0.04
Post-operative length of stay 5.1 4.7 5.1 4.8 5.5 3.3 0.39
Discharge to extended care facility 3.2% (23/728) 2.6% (17/660) 8.8% (6/68) 0.01

Figure 1 – Overall Survival Among Octogenarians at 1, 3, and 5 Years