Thomas P, Sielezneff I, Ragni J, Giudicelli R, Fuentes P
Department of Thoracic Surgery, Sainte-Marguerite Hospital, Marseille, France.
Eur J Cardiothorac Surg. 1993;7(5):246-50; discussion 250-1. doi: 10.1016/1010-7940(93)90212-t.
From January 1980 through January 1985, 452 consecutive patients underwent pulmonary resection for primary non-small cell bronchogenic cancer. Forty-seven patients (10.4%) were 70 years old or older: there were 45 men and 2 women, with a mean age of 72.4 years (S.D.: 2.6; range: 70-79). This population was comparable to the 405 younger patients with respect to the type of resection, histology and TNM staging. Whereas the non-fatal complication rate was similar in both groups (25.5% versus 29.9%), the in-hospital mortality rate was significantly higher in the older patients (12.8% versus 4.7%; P < or = 0.05). The mortality rate after extended resections was significantly higher among the older patients (33.3% versus 6%, P < or = 0.01). The cause of death was myocardial infarction in half the cases; the underlying coronary disease was unrecognized preoperatively in one-third. Five-year survival was comparable in both groups: 29.8% and 33%, respectively. We conclude that pulmonary resection for bronchogenic cancer is justified in patients over 70 years; a careful preoperative assessment ought to be performed and standard resections should be preferred.
从1980年1月至1985年1月，452例连续性患者因原发性非小细胞支气管癌接受了肺切除术。47例患者（10.4%）年龄在70岁及以上：男性45例，女性2例，平均年龄72.4岁（标准差：2.6；范围：70 - 79岁）。就切除类型、组织学和TNM分期而言，该人群与405例较年轻患者具有可比性。两组的非致命并发症发生率相似（分别为25.5%和29.9%），但老年患者的住院死亡率显著更高（分别为12.8%和4.7%；P≤0.05）。扩大切除术后老年患者的死亡率显著更高（分别为33.3%和6%，P≤0.01）。半数病例的死亡原因是心肌梗死；三分之一患者术前未识别出潜在的冠状动脉疾病。两组的五年生存率具有可比性：分别为29.8%和33%。我们得出结论，70岁以上患者因支气管癌行肺切除术是合理的；术前应进行仔细评估，且应首选标准切除术。
