Pagni S, McKelvey A, Riordan C, Federico J A, Ponn R B
Division of Thoracic and Cardiovascular Surgery, Hospital of Saint Raphael, New Haven, CT 06511, USA.
Eur J Cardiothorac Surg. 1998 Jul;14(1):40-4; discussion 44-5. doi: 10.1016/s1010-7940(98)00145-6.
There is an increasing number of elderly patients presenting with potentially-resectable lung malignancy. The objective of this study is to evaluate the modern perioperative morbidity and mortality in patients undergoing oncologic lung resection and to analyse the trend over a 26-year period in our experience.
Between 1971 and 1996, 1506 patients underwent lung resection for malignancy. We reviewed the 30-day perioperative risk in a group of 385 (25.6%) patients aged 70 years and older operated on for intended cure of lung malignancy. Operations included 293 (77%) lobectomies, 24 pneumonectomies (6%), 16 bilobectomies (4%) and 52 wedge or segmental resections (13%). The pathology was bronchogenic carcinoma in 89% and metastasis or other tumours in 11% of patients. We compared the 30-day perioperative risk between the elderly group (age 70 or greater) and a cohort of 180 patients (control) 69 years and younger.
The mortality for all resections in elderly group was 4.2% (16/385) and was 1.6% for the control group. Mortality in the octogenarian group was 2.8%. Female gender correlated with a decreased risk of death, with only two of 16 deaths in females (P < 0.005). Overall morbidity was higher in the study than in control patients (34% vs. 25%, n.s.), although major morbidity was similar in both groups (13.2% vs. 13%). Abnormal pulmonary-function testing and positive cardiac history did not correlate with increase overall or specific risk. Pneumonectomy carried a higher risk for death, with three of 24 deceased (12.5%; P < 0.05). Changes in outcome were analysed over two time periods: the mortality in the early period (1971-1982), 11.1% (8/72), was significantly elevated above the control group, while mortality in the modern period (1983-1994) was not, with a rate of 2.6% (8/313).
In our series, mortality associated with operative treatment for lung malignancy in the elderly declined, so age alone no longer appears to be a risk factor. Age remains a risk factor for overall, but not major, morbidity. Pneumonectomy should undertaken cautiously in this age group. Based on this data, functional elderly patients should not be denied curative lung resection based on age alone.
出现潜在可切除肺部恶性肿瘤的老年患者数量日益增加。本研究的目的是评估接受肿瘤性肺切除患者的现代围手术期发病率和死亡率，并分析我们经验中26年期间的趋势。
1971年至1996年期间，1506例患者因恶性肿瘤接受肺切除。我们回顾了一组385例（25.6%）年龄70岁及以上、旨在治愈肺部恶性肿瘤而接受手术的患者的30天围手术期风险。手术包括293例（77%）肺叶切除术、24例全肺切除术（6%）、16例双肺叶切除术（4%）和52例楔形或节段性切除术（13%）。89%的患者病理为支气管源性癌，11%为转移瘤或其他肿瘤。我们比较了老年组（年龄70岁及以上）与180例69岁及以下患者队列（对照组）之间的30天围手术期风险。
老年组所有切除术的死亡率为4.2%（16/385），对照组为1.6%。八旬老人组的死亡率为2.8%。女性与死亡风险降低相关，女性16例死亡中仅2例（P<0.005）。研究组的总体发病率高于对照组（34%对25%，无统计学意义），尽管两组的主要发病率相似（13.2%对13%）。肺功能测试异常和阳性心脏病史与总体或特定风险增加无关。全肺切除术的死亡风险更高，24例死亡中有3例（12.5%；P<0.05）。在两个时间段分析了结果变化：早期（1971 - 1982年）死亡率为11.1%（8/72），显著高于对照组，而现代期（1983 - 1994年）死亡率与对照组无差异，为2.6%（8/313）。
在我们的系列研究中，老年患者与肺部恶性肿瘤手术治疗相关的死亡率下降，因此仅年龄似乎不再是一个风险因素。年龄仍然是总体发病率的风险因素，但不是主要发病率的风险因素。在这个年龄组进行全肺切除术应谨慎。基于这些数据，不应仅因年龄而拒绝功能良好的老年患者进行根治性肺切除。
