Minimal-invasive approach is associated with reduced cardiopulmonary complications in elderly patients > 70 years undergoing curative intent surgery for T1/2 lung cancer

Background:

The number of elderly patients undergoing lung resection for lung cancer is continuously increasing. This retrospective study aimed to investigate the risk factors of postoperative complications in elderly lung cancer patients and the role of surgical approach in the early postoperative outcome in this cohort.

Material and method:

We reviewed all consecutive patients who underwent open and minimal-invasive curative intent anatomical resection for T1/2 lung cancer from 1/2016 to 11/2018 at our institution. Two groups (≥70 years and < 70 years) were compared. Preoperative and postoperative clinical data, hospital stay and 30- and 90- day mortality were prospectively collected. Postoperative complications and early postoperative outcome were assessed and compared between the two groups.

Result:

505 (278 male, 227 female) patients (n = 315, 62% < 70 years, n = 190, 38% ≥70 years) have been identified. 48% (n = 241) had thoracotomy, 52% (n = 264) were operated with a minimal invasive approach either by VATS or RATS. 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 below70 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). 30- and 90-day mortality was comparable with 1.4% and 1.5%, respectively.

Conclusion:

Lung 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 in this cohort and should be the preferred approach.