Original article
General thoracic
Risk Factors for Morbidity After Lobectomy for Lung Cancer in Elderly Patients

https://doi.org/10.1016/j.athoracsur.2009.06.012Get rights and content

Background

Studies evaluating risk factors for complications after lobectomy in elderly patients have not adequately analyzed the effect of using minimally invasive approaches.

Methods

A model for morbidity including published preoperative risk factors and surgical approach was developed by multivariable logistic regression. All patients aged 70 years or older who underwent lobectomy for primary lung cancer without chest wall resection or airway procedure between December 1999 and October 2007 at a single institution were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Morbidity was measured as a patient having any perioperative complication. The impact of bias in the selection of surgical approach was assessed using propensity scoring.

Results

During the study period, 338 patients older than 70 years (mean age, 75.7 ± 0.2) underwent lobectomy (219 thoracoscopy, 119 thoracotomy). Operative mortality was 3.8% (13 patients) and morbidity was 47% (159 patients). Patients with at least one complication had increased length of stay (8.3 ± 0.6 versus 3.8 ± 0.1 days; p < 0.0001) and mortality (6.9% [11 of 159] versus 1.1% [2 of 179]; p = 0.008). Significant predictors of morbidity by multivariable analysis included age (odds ratio, 1.09 per year; p = 0.01) and thoracotomy as surgical approach (odds ratio, 2.21; p = 0.004). Thoracotomy remained a significant predictor of morbidity when the propensity to undergo thoracoscopy was considered (odds ratio, 4.9; p= 0.002).

Conclusions

Patients older than 70 years of age can undergo lobectomy for lung cancer with low morbidity and mortality. Advanced age and the use of a thoracotomy increased the risk of complications in this patient population.

Section snippets

Patients and Methods

After local institutional review board approval was granted, the Duke University Medical Center Data Center was queried for current procedural terminology codes linked with pulmonary resection by either an open approach or by a thoracoscopic approach between December 1999 and October 2007. Careful attention was paid to individual operative notes and surgical pathology reports to identify all patients older than 70 years age who underwent anatomic lobectomy. Patients who had a completion

Results

During the study period, 971 patients older than 70 underwent lung resection. Of these, 338 patients (median age of 75) underwent lobectomy for lung cancer: 119 patients underwent thoracotomy and 219 patients underwent thoracoscopy. The distribution performed per study year is depicted in Figure 1. Lobectomy was performed in 1,578 patients overall during the study period. Therefore, the number evaluated in this report represents approximately 21% of the total number of lobectomies.

Demographic,

Comment

This study demonstrates that lobectomy can be performed for non–small cell lung cancer in patients older than 70 with acceptable overall morbidity and mortality (3.8% and 47%, respectively). These results are in the range of those published from other multiinstitution and single-institution series [6, 12, 28, 29, 30, 31]. Despite the significant comorbid conditions listed in Table 1, the majority of patients did not experience a postoperative complication. Our analysis demonstrates that age and

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