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The Journal of Cardiovascular Surgery 1999 October;40(5):715-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Resection for bronchogenic carcinoma in the elderly

Oliaro A., Leo F., Filosso P. L., Rena O., Parola A., Maggi G.

From the Thoracic Surgery Department University of Turin, Turin, Italy


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Background. The aim of ­this ­report was to ­assess post­op­er­a­tive com­pli­ca­tions, mor­tal­ity and ­long ­term sur­vi­val of sur­gi­cal ther­a­py for non ­small ­cell ­lung can­cer in ­patients ­aged 70 ­years or ­more. Results and the sig­nif­i­cance of var­i­ous prog­nos­tic fac­tors ­were ana­lysed.
Methods. At Thoracic Surgery Department of Torino, ­from January 1980 to December 1997, 258 ­patients ­aged 70 years or more were oper­at­ed on for ­lung can­cer. For the ­first 11 ­years of the ­series, ­more restric­tive selec­tion cri­te­ria ­were adopt­ed (clin­i­cal ­stage I or II ­lung can­cer, ­absence of ­major con­com­i­tant dis­ease or pre­vi­ous malig­nan­cy in the ­last 5 ­years); 60 ­patients ­were oper­at­ed in ­this peri­od. After 1990, ­such cri­te­ria ­were no long­er con­sid­ered man­da­to­ry; ­since ­then 198 ­patients ­have ­been oper­at­ed. Clinical ­data are ­reviewed in the ­seach for pre­dic­tors of mor­tal­ity and mor­bid­ity and sur­vi­val ­data are ana­lysed.
Results. Overall post­op­er­a­tive mor­tal­ity was 3.1% and mor­bid­ity was 39.1%. Pneumonectomy result­ed in high­er ­rate of mor­tal­ity (9.1%, p 0.03). Complications ­proved to be ­more fre­quent in ­patients ­with con­com­i­tant dis­ease (55.5%). Multivariate anal­y­sis on sur­vi­val ­showed the impor­tance of ­stage (5 ­years sur­vi­val was 73.6% in ­stage I, 23% in ­stage II, 8.9% in ­stage IIIa) and ­type of selec­tion (57% for the high­ly select­ed, 40% for the oth­ers).
Conclusions. Selection cri­te­ria ­have the ­same ­impact on sur­vi­val as ­stage in sur­gi­cal treat­ment of ­lung can­cer in the eld­er­ly. This fac­tor ­should be ana­lysed in ­series cov­er­ing a ­long peri­od of ­time. Low mor­tal­ity and accept­able ­long ­term sur­vi­val ­from ­this ­study con­firmed ­that sur­gery is worth­while in eld­er­ly ­patients.

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