Department of Thoracic Surgery, San Giovanni Hospital, Ente Ospedaliero Cantonale Bellinzona, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland.
Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5129-5136. doi: 10.26355/eurrev_202108_26525.
Surgery is the mainstay of early-stage lung cancer treatment. However, since life expectancy is constantly increasing, we wanted to investigate whether this principle also applies to elderly (≥70-year-old) patients.
We analyzed a prospectively maintained database on anatomical lung resections at our institute. Patients were divided in two groups: <70 years and ≥70 years (elderly). Outcome indicators were postoperative cardiopulmonary complications rate and 30-day readmission rate. Baseline and surgical characteristics were compared by mean of t-test, Mann-Whitney U test, chi2 and Fisher exact tests. Propensity score matching was performed to account for differences between groups in the outcome's analysis.
We selected 241 patients with lung cancer (2017-2021) who underwent anatomical lung resections. Median age was 70.5 (IQR: 64-76). 133 patients (54%) aged 70 and above. Patients and surgical characteristics (comorbidities, lung function, performance status, type and extension of lung resection and surgical approach) were similar among groups, except for atrial fibrillation (p=0.01) and previous cancer history (p<0.0001) which were more frequent in the elderly group. Non-elderly patients were more frequently active smokers (p<0.0001). Cardiopulmonary complications rate was 23%, 30-day readmission rate was 12.6%. We did not observe any significant difference in all the short-term outcome indicators between the elderly and the younger counterpart. Particularly, complications rate (p=0.91) and 30-day readmission (p=0.84) did not differ between groups.
In our series, short-term outcomes are not compromised in elderly patients. The evolution in surgical strategy and expertise contribute to offer surgical resection with curative intent for lung cancer to a large spectrum of patients.
手术是早期肺癌治疗的主要手段。然而，由于预期寿命不断延长，我们想研究这一原则是否也适用于老年人（≥70 岁）患者。
我们分析了我院解剖性肺切除术的前瞻性维护数据库。患者分为两组：<70 岁和≥70 岁（老年组）。术后心肺并发症发生率和 30 天再入院率为结局指标。采用 t 检验、Mann-Whitney U 检验、卡方检验和 Fisher 确切检验比较两组的基线和手术特征。采用倾向评分匹配法分析两组间结局的差异。
我们选择了 2017-2021 年间接受解剖性肺切除术的 241 例肺癌患者。中位年龄为 70.5（IQR：64-76）岁。≥70 岁的患者 133 例（54%）。两组患者和手术特征（合并症、肺功能、体力状态、肺切除术类型和范围以及手术方式）相似，除心房颤动（p=0.01）和既往癌症史（p<0.0001）外，老年组更为常见。非老年组中活跃吸烟者更为常见（p<0.0001）。心肺并发症发生率为 23%，30 天再入院率为 12.6%。我们未观察到老年组与年轻组在所有短期结局指标上存在显著差异。特别是，并发症发生率（p=0.91）和 30 天再入院率（p=0.84）两组间无差异。
在我们的系列研究中，老年患者的短期结局并未受到影响。手术策略和专业知识的发展有助于为广泛的患者提供以治愈为目的的肺癌手术切除。
