Outcomes of video‐assisted thoracoscopic surgery lobectomy in septuagenarians

• Published in: ANZ journal of surgery Vol. 90; no. 5; pp. 752 - 756
• Main Authors: Fong, Laura S., Ko, Viktor, Mclaughlin, Aden, Okiwelu, Ngozichukwuka Louis, Newman, Mark A., Passage, Jurgen, Sanders, Lucas H. A., Joshi, Pragnesh V.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2020; Blackwell Publishing Ltd
• Subjects: Aged; Air leakage; Arrhythmia; Cerebral infarction; Complications; Delirium; Fibrillation; Fistulae; Geriatrics; Heart attacks; Humans; Length of Stay; lobectomy; Lung; Lung cancer; Lung carcinoma; Lung diseases; Lung Neoplasms - surgery; Mental disorders; Metastases; Mortality; Myocardial infarction; Neuroendocrine tumors; Non-small cell lung carcinoma; Older people; Ostomy; Patients; Pneumonectomy; Respiratory failure; Retrospective Studies; septuagenarian; Surgery; Thoracic Surgery, Video-Assisted; Thoracotomy; video‐assisted thoracoscopic surgery; septuagenarian; video-assisted thoracoscopic surgery; lobectomy
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15788

Background Spread of technology and increased surveillance have led to more patients with lung cancers being identified than ever before. Increasingly, patients from the elderly population are referred for surgery; however, many studies do not focus on this patient group. We reviewed the outcomes of septuagenarians who underwent lobectomy via an open thoracotomy (OT) or video‐assisted thoracoscopic surgery (VATS) approach to determine whether the VATS approach would result in superior post‐operative outcomes. Methods Between January 2010 and June 2016, a total of 96 patients aged 70 years or older underwent a lobectomy for non‐small cell lung carcinoma. Patients who underwent resection for metastatic disease, small cell lung cancer or neuroendocrine tumour were excluded. Demographic details, early and late post‐operative outcomes including post‐operative arrhythmia, myocardial infarction, respiratory failure, cerebrovascular events, infection, prolonged air leak, delirium, readmission and 30‐day mortality were studied. Mean follow‐up duration was 23 ± 19.1 months. Results Seventy‐five patients underwent lobectomy via a VATS approach and 21 patients underwent lobectomy via an OT approach. There was no 30‐day mortality and no difference in overall survival between the two techniques (P = 0.25). There was no significant difference between the two techniques with regard to post‐operative stroke, myocardial infarction, atrial fibrillation, pneumonia, delirium or bronchopleural fistula. VATS patients had a significantly shorter mean hospital length of stay (VATS 4.7 days, OT 9.3 days, P = 0.005). Conclusion Septuagenarians with non‐small cell lung carcinoma can successfully undergo curative lung resection with a low incidence of post‐operative complications. Septuagenarians with non‐small cell lung carcinoma can successfully undergo curative lung resection with a low incidence of post‐operative complications. A video‐assisted thoracoscopic surgery approach to surgical resection results in similar post‐operative outcomes to open thoracotomy; however, the significantly shorter mean hospital length of stay may be clinically relevant in this elderly population.