McVay Carie L, Pickens Allan, Fuller Clark, Houck Ward, McKenna Robert
Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Am Surg. 2005 Sep;71(9):791-3.
Although modern techniques in anesthesia and surgery have reduced morbidity and mortality for pulmonary resection, some physicians still consider advanced age a contraindication to resection of lung cancer. We examined our experience with VATS lobectomy in octogenarians at Cedars-Sinai Medical Center over 12 years (1992-2004). There were 159 patients. Mean age was 83 years (range, 80-94 years) consisting of 61 males (38%) and 96 females (62%). Operations included 153 lobectomies (96%), 3 bilobectomies (2%), and 3 pneumonectomies (2%). Two operations were converted to thoracotomy (1%), one due to bleeding, and one due to poor visualization. Median hospital stay was 4.00 +/- 6.39 days. One hundred thirty-one patients (82%) had no complications. The most common complication was arrhythmias occurring in 8/159 (5%) patients. There were three perioperative deaths (1.8%). Pathology revealed 104 adenocarcinomas (65%), 25 squamous cell carcinomas (16%), 5 adeno-squamous carcinomas (3%), 7 bronchoalveolar carcinomas (4%), 7 large cell carcinomas (4%), 4 carcinoid tumors (3%), 4 non-small cell lung cancer (NSCLC) (3%), 1 mucoepidermoid carcinoma (< 1%), 1 lymphoma (< 1%), and 1 pulmonary metastasis (< 1%). Median follow-up was 29 months. The results of this series show that age alone is not a contraindication to the surgical treatment of lung cancer.
尽管现代麻醉和手术技术已降低了肺切除的发病率和死亡率，但一些医生仍认为高龄是肺癌切除的禁忌证。我们回顾了在1992年至2004年的12年间，雪松西奈医疗中心对八旬老人行电视辅助胸腔镜肺叶切除术的经验。共有159例患者。平均年龄为83岁（范围80 - 94岁），其中男性61例（38%），女性96例（62%）。手术包括153例肺叶切除术（96%）、3例双叶切除术（2%）和3例全肺切除术（2%）。2例手术转为开胸手术（1%），1例因出血，1例因视野不佳。中位住院时间为4.00±6.39天。131例患者（82%）无并发症。最常见的并发症是心律失常，发生在8/159（5%）的患者中。围手术期死亡3例（1.8%）。病理显示104例腺癌（65%）、25例鳞状细胞癌（16%）、5例腺鳞癌（3%）、7例细支气管肺泡癌（4%）、7例大细胞癌（4%）、4例类癌肿瘤（3%）、4例非小细胞肺癌（NSCLC）（3%）、1例黏液表皮样癌（<1%）、1例淋巴瘤（<1%）和1例肺转移瘤（<1%）。中位随访时间为29个月。该系列结果表明，仅年龄并非肺癌手术治疗的禁忌证。
