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Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery.
Ann Thorac Surg. 2011 Dec; 92(6):1951-7.AT

Abstract

BACKGROUND

As the population ages, clinicians are increasingly confronted with octogenarians with resectable non-small cell lung cancer (NSCLC). We reviewed the outcomes of octogenarians who underwent lobectomy for NSCLC by video-assisted thoracic surgery (VATS) versus open thoracotomy, to determine if there was a benefit to the VATS approach in this group.

METHODS

We conducted a retrospective single-institution review of patients age 80 years or greater who underwent a lobectomy for NSCLC from 1998 to 2009. Outcomes including complication rates, length of stay, disposition, and long-term survival were analyzed.

RESULTS

One hundred twenty-one octogenarians underwent lobectomy: 40 VATS and 81 through open thoracotomy. Compared with thoracotomy, VATS patients had fewer complications (35.0% vs 63.0%, p = 0.004), shorter length of stay (5 vs 6 days, p = 0.001), and were less likely to require admission to the intensive care unit (2.5% vs 14.8%, p = 0.038) or rehabilitation after discharge (5% vs 22.5%, p = 0.015). In multivariate analysis, VATS was an independent predictor of reduced complications (odds ratio, 0.35; 95% confidence interval, 0.15 to 0.84; p = 0.019). Survival comparisons demonstrated no significant difference between the two techniques, either in univariate analysis of stage I patients (5-year VATS, 76.0%; thoracotomy, 65.3%; p = 0.111) or multivariate analysis of the entire cohort (adjusted hazard ratio, 0.59; 95% confidence interval, 0.27 to 1.28; p = 0.183).

CONCLUSIONS

Octogenarians with NSCLC can undergo resection with low mortality and survival among stage I patients, which is comparable with the general lung cancer population. The VATS approach to resection reduces morbidity in this age demographic, resulting in shorter, less intensive hospitalization, and less frequent need for postoperative rehabilitation.

Authors+Show Affiliations

Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021, USA. jlp2002@med.cornell.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21982148

Citation

Port, Jeffrey L., et al. "Lobectomy in Octogenarians With Non-small Cell Lung Cancer: Ramifications of Increasing Life Expectancy and the Benefits of Minimally Invasive Surgery." The Annals of Thoracic Surgery, vol. 92, no. 6, 2011, pp. 1951-7.
Port JL, Mirza FM, Lee PC, et al. Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery. Ann Thorac Surg. 2011;92(6):1951-7.
Port, J. L., Mirza, F. M., Lee, P. C., Paul, S., Stiles, B. M., & Altorki, N. K. (2011). Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery. The Annals of Thoracic Surgery, 92(6), 1951-7. https://doi.org/10.1016/j.athoracsur.2011.06.082
Port JL, et al. Lobectomy in Octogenarians With Non-small Cell Lung Cancer: Ramifications of Increasing Life Expectancy and the Benefits of Minimally Invasive Surgery. Ann Thorac Surg. 2011;92(6):1951-7. PubMed PMID: 21982148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery. AU - Port,Jeffrey L, AU - Mirza,Farooq M, AU - Lee,Paul C, AU - Paul,Subroto, AU - Stiles,Brendon M, AU - Altorki,Nasser K, Y1 - 2011/10/07/ PY - 2011/03/24/received PY - 2011/06/20/revised PY - 2011/06/22/accepted PY - 2011/10/11/entrez PY - 2011/10/11/pubmed PY - 2012/1/18/medline SP - 1951 EP - 7 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 92 IS - 6 N2 - BACKGROUND: As the population ages, clinicians are increasingly confronted with octogenarians with resectable non-small cell lung cancer (NSCLC). We reviewed the outcomes of octogenarians who underwent lobectomy for NSCLC by video-assisted thoracic surgery (VATS) versus open thoracotomy, to determine if there was a benefit to the VATS approach in this group. METHODS: We conducted a retrospective single-institution review of patients age 80 years or greater who underwent a lobectomy for NSCLC from 1998 to 2009. Outcomes including complication rates, length of stay, disposition, and long-term survival were analyzed. RESULTS: One hundred twenty-one octogenarians underwent lobectomy: 40 VATS and 81 through open thoracotomy. Compared with thoracotomy, VATS patients had fewer complications (35.0% vs 63.0%, p = 0.004), shorter length of stay (5 vs 6 days, p = 0.001), and were less likely to require admission to the intensive care unit (2.5% vs 14.8%, p = 0.038) or rehabilitation after discharge (5% vs 22.5%, p = 0.015). In multivariate analysis, VATS was an independent predictor of reduced complications (odds ratio, 0.35; 95% confidence interval, 0.15 to 0.84; p = 0.019). Survival comparisons demonstrated no significant difference between the two techniques, either in univariate analysis of stage I patients (5-year VATS, 76.0%; thoracotomy, 65.3%; p = 0.111) or multivariate analysis of the entire cohort (adjusted hazard ratio, 0.59; 95% confidence interval, 0.27 to 1.28; p = 0.183). CONCLUSIONS: Octogenarians with NSCLC can undergo resection with low mortality and survival among stage I patients, which is comparable with the general lung cancer population. The VATS approach to resection reduces morbidity in this age demographic, resulting in shorter, less intensive hospitalization, and less frequent need for postoperative rehabilitation. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/21982148/Lobectomy_in_octogenarians_with_non_small_cell_lung_cancer:_ramifications_of_increasing_life_expectancy_and_the_benefits_of_minimally_invasive_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(11)01593-1 DB - PRIME DP - Unbound Medicine ER -