Dell'Amore Andrea, Monteverde Marco, Martucci Nicola, Sanna Stefano, Caroli Guido, Stella Franco, Dell'Amore Davide, Rocco Gaetano
Thoracic Surgery Operative Unit, S. Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
Interact Cardiovasc Thorac Surg. 2013 Mar;16(3):250-6. doi: 10.1093/icvts/ivs473. Epub 2012 Nov 23.
Older lung cancer patients with multiple morbidities are increasingly referred to thoracic surgery departments. The aim of this multicenter study was to analyse the prognostic factors for in-hospital morbidity and mortality and to elucidate the predictors of long-term survival and oncological outcomes.
We identified 319 patients aged ≥ 75 years who underwent intended curative lung resection for lung cancer in three different thoracic surgery departments between January 2000 and December 2010.
Seventy-one patients underwent limited resection, 202 had lobectomy, 16 had bilobectomy and 30 had pneumonectomy. The in-hospital mortality was 6.6%. Chronic renal failure, low respiratory reserve and pneumonectomy were predictors of in-hospital mortality. The mean follow-up time was 3.9 years, ranging from 1 month to 10.4 years. The disease-free survivals at 1, 3 and 5 years were 82, 60 and 47%, respectively. The overall survivals at 1, 3 and 5 years were 86, 59 and 38%, respectively. The long-term overall survival was negatively influenced by pneumonectomy, extended resection, N(1-2) subgroups and pathological TNM stage.
Nowadays, we can consider surgery a safe and justifiable option for elderly patients. Careful preoperative work-up and selection are mandatory to gain satisfactory results. Good long-term results were achieved in elderly patients with early stage who underwent lobar or sublobar lung resection. The role of surgery or other alternative therapies, in patients with advanced stages, extensive nodal involvement and/or requiring extensive surgical resection for curative intent, is still unclear and further studies are certainly needed.
患有多种疾病的老年肺癌患者越来越多地被转诊至胸外科。这项多中心研究的目的是分析院内发病和死亡的预后因素，并阐明长期生存和肿瘤学结局的预测因素。
我们确定了2000年1月至2010年12月期间在三个不同胸外科接受意向性根治性肺癌肺切除术的319例年龄≥75岁的患者。
71例患者接受了局限性切除术，202例进行了肺叶切除术，16例进行了双叶切除术，30例进行了全肺切除术。院内死亡率为6.6%。慢性肾功能衰竭、低呼吸储备和全肺切除术是院内死亡的预测因素。平均随访时间为3.9年，范围从1个月至10.4年。1年、3年和5年的无病生存率分别为82%、60%和47%。1年、3年和5年的总生存率分别为86%、59%和38%。全肺切除术、扩大切除术、N(1-2)亚组和病理TNM分期对长期总生存有负面影响。
如今，我们可以认为手术对于老年患者是一种安全且合理的选择。必须进行仔细的术前检查和选择以获得满意的结果。接受肺叶或肺段肺切除术的早期老年患者取得了良好的长期效果。对于晚期、广泛淋巴结受累和/或为达到根治目的需要广泛手术切除的患者，手术或其他替代疗法的作用仍不明确，肯定需要进一步研究。
