C77-28 Octogenarians With Early-Stage Lung Cancer: A Clinical, Radiological, and Pathological Comparison of Patients Who Underwent Lobectomy vs. Sublobar Resection

Background Determining surgical extent for early-stage non-small cell lung cancer (NSCLC) in octogenarians presents a clinical challenge, requiring a balance between perioperative risk and cure rate. This study aimed to characterize and compare clinical, pathological, and postoperative outcomes among patients aged ≥80 who underwent lobectomy or sublobar resection (wedge resection or segmentectomy) within the Initiative for Early Lung Cancer Research on Treatment (IELCART) cohort. Methods We reviewed all patients (ages ≥80) with a first primary NSCLC, ≤30mm in maximum diameter (cT1a-T1bN0M0, 8th ed TNM), enrolled in the IELCART study from 2016, who underwent lobectomy or sublobar resection. Differences were compared using the χ2 test or Fisher’s exact test for categorical variables and the two-sample t test or Wilcoxon rank-sum test for continuous variables. We also reviewed pre-treatment surgery forms to compare whether octogenarians and non-octogenarians had multiple surgical resection options. Results Of 114 patients, 90 underwent sublobar resection and 24 lobectomies. Sex was evenly distributed. Most were White (80%), non-Hispanic (89%), and former smokers (73% vs 25% never-smoker, 2% current smoker). Comorbidities, including hypertension, COPD, cardiac disease, and diabetes, did not differ between groups. Most nodules were solid (75%), with no difference between lobectomy and sublobar groups (79% vs 73%; p = 0.6). Lobectomy group had larger nodules on pre-op CT (median: 20 mm vs 15 mm; p = 0.059), larger resected tumors (median: 24 mm vs 18 mm; p < 0.001). Adenocarcinoma was predominant in both groups (83% vs 89%), with rates of angiolymphatic (42% vs 40%) and vascular invasion (8.3% vs 2.2%, p = 0.2). Median hospital stay was longer post-lobectomy (5 vs 3 days, p < 0.001). ICU care was required for 2.6% of patients. Overall complication rate was 40% (46% for lobectomy and 39% for sublobar), with more pulmonary complications post-lobectomy (21% vs 5.6%,p=0.033) (Table 1). Baseline characteristics and comorbidities were similar between those with and without complications. In the sublobar group, complications were associated with lower lobe nodules, longer stays, and more 30-day readmissions. Among 50 patients with pre-surgery forms, 15 octogenarians (30%) had multiple surgical options considered, with 87% undergoing sublobar resection. Among 431 non-octogenarians, 234 (54%) had multiple options considered, with 153 (65%) receiving sublobar resection. Conclusions Complications were likely associated with the surgical extent, as comorbidities were comparable between groups. Among octogenarians, sublobar resection emerged as the predominant surgical approach, reflecting individualized surgical decision-making rather than patient frailty. Continued analysis will help clarify postoperative outcomes and guide surgical management in this growing population.