Specific risks and outcomes of octogenarians post-lung cancer resection: our 5-year experience

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Background: An increasingly large proportion of patients undergoing curative surgery for lung cancer, are octogenarians. We evaluated our short and long-term survival and adverse outcomes after oncological lung resections. Methods: Octogenarians undergoing anatomical resection for confirmed or suspected lung cancer at a single-centre between January 2016 and December 2021 were included. Retrospective analysis of demographic, clinical, and operative data was performed and correlated with mortality and long-term outcomes. Results: Out of 214 patients, 189 were included in the final analysis. Median age was 82 years (range, 80-89 years). Most patients had lobectomies and minimally invasive approach. Ninety-day mortality was 3.2% with no intraoperative deaths. Chronic obstructive pulmonary disease (COPD) primarily conferred a greater likelihood of persistent air leak (PAL), chest infection, reintubation and intensive care admission (all P<0.01). Complications occurred more in those with high white cell counts (WCCs) (P=0.03) and squamous cell carcinoma subtype (P<0.01). Wedge resections conferred fewer complications (P=0.049). Hospital length of stay (LOS) was reduced by 1 day in sublobar resections (P=0.01) and halved in minimally invasive approaches compared to thoracotomy (P=0.02). The median overall survival (OS) was 3.5 years (1-, 3-, and 5-year survival was 82.5%, 57.1%, and 38.2%, respectively). Pathological tumour stage (P<0.01) and incomplete resection (R1 or R2) (P=0.02) conferred a worse OS and disease-free survival (DFS). Median DFS was 2.4 years. No significant difference was seen in OS or DFS from extent of resection or tumour subtype (P=0.78, P=0.97 and P=0.40, P=0.91). Conclusions: Curative surgery is safe and feasible with good long-term outcomes in appropriately selected octogenarians. Predictors of specific complications can be identified and optimised in order to better counsel patients pre-operatively and offer surgery at an early pathological stage.

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