Clinical course and surgical long-term outcome in geriatric patients with non-small cell carcinoma

The purpose of this study was to determine clinical patterns, trends of outcome and survival in elderly patients with surgery for non-small cell lung carcinoma (NSCLC). Methods: 273 patients aged over 70 years who underwent curative resection for NSCLC, from 1995 to 2005, were followed-up. Analysis was performed with respect to preoperative conditions, surgery, histology, morbidity, mortality, and length of survival. Results: Mean age was 73.2±3.1 years. 31 (11.3%) patients were older than 80 years, consisting of 170 (62.2%) males, with a mean follow-up of 31 months. Most patients (n=237) received standard procedures: 200 bi- and lobectomies, 42 pneumonectomies, 9 sleeve resections and 22 wedge resections. 36 patients underwent extended resections for tumors involving, the chest wall (n=25), mediastinum (n=7) and pericardium (n=4). Thirty-day mortality was 5.4% with 25.9% developing pulmonary and 5.3% major cardiovascular complications. Multivariate analysis showed that extended procedures (p=0.0001), male gender (p=0.0001), low FEV1 (p=0.02) and age (p=0.02) were independent predictors of early mortality. Overall survival rates at 5 and 10 years were 35.6% and 10.5% respectively. Multivariate analysis showed that advanced disease stage (p=0.0001), low FEV1 (p=0.003), previous cardiac disease (p=0.01) and hypertension (p=0.03) were independent predictors which influenced survival. Conclusions: Properly selected geriatric patients with stage I–II NSCLC can be resected safely with acceptable morbidity and long-term survival. Substantial survival rates may also be achieved in stage IIIA patients in the absence of a macroscopically N2 disease. Lobectomy is the procedure of choice, extended resections should only be carried out in highly selected patients.