Anatomical pulmonary resections for primary lung cancer in octogenarians within a dedicated care protocol

Charlotte Cohen, Saleh Al Orainy, Daniel Pop, Michel Poudenx, Josiane Otto, Jean-Philippe Berthet, Nicolas Venissac, Jérome Mouroux


Background: The aim of this study was to assess the feasibility of major pulmonary resection for a limited non-small cell lung cancer (NSCLC) in octogenarians within a dedicated care protocol.
Methods: We retrospectively analyzed data of 55 octogenarians operated on in a single institution between January 2005 and December 2016. They were all included in a specific care protocol with systematic geriatric assessment and adaptation of the peri-operative care. We describe the results of post-operative morbidity, mortality, and survival after anatomical resection and radical lymphadenectomy.
Results: Mean age at the time of surgery was 82.1 years (80–86 years). Median Charlson’s comorbidity score was 0 (0–3). All patients were classified Balducci 1 or 2. We performed 2 pneumonectomies (3%), 3 bilobectomies (5%), 47 lobectomies (85%) and 3 segmentectomies (5%). The median hospital stay was 11.5 days (7–31 days). The 30-day mortality rate was 3%. The total of relevant clinical complications (Clavien 3 to 5) was 16% (n=9). The Overall Survival at one, three and five years were, respectively: 83% (95% CI: 75–95%); 70% (95% CI: 56–87%); 58% (95% CI: 43–79%).
Conclusions: Major pulmonary resection for primary lung cancer in octogenarians seems to be safe, with an acceptable morbidity, mortality and long-term survival rate, when processing to rigorous selection of the patients, within a dedicated care protocol.