Is lung cancer resection justified in patients aged over 70 years?

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.