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
