Minimal-invasive approach reduces cardiopulmonary complications in elderly after lung cancer surgery

Mohamed Zaatar, Theresa Stork, Daniel Valdivia, Khaled Mardanzai, Dirk Stefani, Stéphane Collaud, Pauline Poellen, Balazs Hegedus, Till Ploenes, Clemens Aigner, Mohamed Zaatar, Theresa Stork, Daniel Valdivia, Khaled Mardanzai, Dirk Stefani, Stéphane Collaud, Pauline Poellen, Balazs Hegedus, Till Ploenes, Clemens Aigner

Abstract

Background: The number of elderly patients undergoing lung resection for lung cancer is continuously increasing. This study investigates the risk factors for postoperative complications in elderly lung cancer patients and the role of surgical approach in early postoperative outcome.

Methods: We reviewed all consecutive patients who underwent anatomical resection for early stage T1/2 lung cancer in a curative intent between January 2016 and November 2018 at our institution. Clinical data, postoperative complications, hospital stay and 30- and 90-day mortality were prospectively collected.

Results: A total of 505 (278 male) patients were included. One hundred ninety patients (38%) were ≥70 years of age. Forty-eight percent (n=241) had thoracotomy, 52% (n=264) were operated with video-assisted or robot-assisted thoracoscopy. Major cardiopulmonary complications were observed in 4.2% (n=21) patients. There was no significant difference in major cardiopulmonary complication rate following minimally invasive surgery between patients above or below 70 years of age (4.3% vs. 2.5%, P=0.47). In contrast, major cardiopulmonary complication rate was significantly higher in elderly thoracotomy patients than in patients below 70 years of age (9.9% vs. 2.6%, P=0.035). Elderly patients operated minimally invasive had a significantly shorter hospital stay compared to open approach (8.1 vs. 11.9 days, P<0.0001). Thirty- and 90-day mortality was comparable with 1.4% and 1.5%, respectively.

Conclusions: Pulmonary resection for lung cancer in elderly patients is safe and can be performed with a low morbidity and mortality. However, our results indicate that minimal invasive surgery leads to reduced postoperative complications especially in elderly and should be the preferred approach.

Keywords: Early stage lung cancer; cardiopulmonary complication; elderly; minimally invasive surgery; thoracotomy.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.73). The authors have no conflicts of interest to declare.

2020 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1
Figure 1
Overall complication rate in both age groups.
Figure 2
Figure 2
Major cardiopulmonary complications in open and minimal-invasive cohort. MI, minimal invasive.

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