Karasaki Takahiro, Fujimori Sakashi, Suzuki Souichiro, Kikunaga Shinichiro, Hamada Yosuke, Mihara Shusei
Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, JPN.
Cureus. 2025 Apr 13;17(4):e82186. doi: 10.7759/cureus.82186. eCollection 2025 Apr.
Introduction With the global trend of aging populations, the number of nonagenarians diagnosed with malignancies, including lung cancer, is increasing. Despite advancements in minimally invasive surgical techniques, lung resection for nonagenarians remains rare due to concerns regarding comorbidities and surgical risks. This study evaluates the surgical outcomes of lung resection in nonagenarians and introduces a holistic assessment approach to optimize patient care. Methods A retrospective review of surgical records from January 2011 to December 2022 identified seven nonagenarians who underwent lung resection under 3-port video-assisted thoracoscopic surgery (VATS). Patient characteristics, surgical details, and postoperative outcomes were analyzed. To holistically evaluate each patient, multifaceted surgical tolerance and prognostic factors were summarized and visualized in a radar plot. Results The study cohort consisted of four males and three females aged 90 to 96 years. Wedge resection was performed in six patients, and one patient underwent lobectomy. Mediastinal lymph node dissection was not performed. The median duration of chest tube insertion was two days, and 86% of patients were discharged within one week. Postoperative complications were minimal, with one case of delirium and no occurrences of pneumonia. All patients were discharged in stable condition without deterioration of their activities of daily living. The median overall survival was 4.1 years. One patient succumbed to lung cancer progression, while the remaining patients exhibited favorable long-term survival without recurrence, including one patient whose lung tumor was a metastasis from colorectal cancer. As depicted in the radar plots, all patients had at least one risk factor other than their age. Conclusion Lung resection under a minimally invasive approach is feasible for carefully selected nonagenarians, yielding favorable short- and long-term outcomes. Because super-elderlies likely harbor multiple comorbidities, a holistic assessment of each patient is important for personalized patient care.
引言 随着全球人口老龄化趋势，包括肺癌在内的被诊断为恶性肿瘤的九旬老人数量正在增加。尽管微创外科技术有所进步，但由于对合并症和手术风险的担忧，九旬老人的肺切除术仍然很少见。本研究评估了九旬老人肺切除术的手术结果，并介绍了一种全面评估方法以优化患者护理。方法 回顾性分析2011年1月至2022年12月的手术记录，确定了7例在三端口电视辅助胸腔镜手术（VATS）下接受肺切除术的九旬老人。分析患者特征、手术细节和术后结果。为了全面评估每位患者，在雷达图中总结并可视化多方面的手术耐受性和预后因素。结果 研究队列包括4名男性和3名女性，年龄在90至96岁之间。6例患者进行了楔形切除术，1例患者接受了肺叶切除术。未进行纵隔淋巴结清扫。胸腔引流管插入的中位时间为2天，86%的患者在一周内出院。术后并发症极少，1例出现谵妄，无肺炎发生。所有患者均病情稳定出院，日常生活活动能力未恶化。中位总生存期为4.1年。1例患者死于肺癌进展，其余患者长期生存良好，无复发，其中1例患者的肺肿瘤为结直肠癌转移灶。如雷达图所示，所有患者除年龄外至少有一个风险因素。结论 对于精心挑选的九旬老人，微创方法下的肺切除术是可行的，可产生良好的短期和长期结果。由于超高龄老人可能存在多种合并症，对每位患者进行全面评估对于个性化患者护理很重要。
