Pneumonectomy for lung cancer in the elderly: lessons learned from a multicenter study
Por:
Minervini, F, Kocher, G, Bertoglio, P, Kestenholz, P, Munoz, C, Patrini, D, Ceulemans, L, Begum, H, Lutz, J, Shojai, M, Shargall, Y and Scarci, M
Publicada:
1 oct 2021
Ahead of Print:
1 sep 2021
Resumen:
Background: 60% of patients diagnosed with lung cancer are older than 65 years and are at risk for substandard treatment due to a reluctance to recommend surgery. Pneumonectomy remains a high risk procedure especially in elderly patients. Nevertheless, the impact of age and neoadjuvant treatment on outcomes after pneumonectomy is still not well described. Methods: We performed a multicentric retrospective study, analyzing outcomes of patients older than 70 years who underwent pneumonectomy for central primary lung malignancy between January 2009 and June 2019 in 7 thoracic surgery departments: Lucerne and Bern (Switzerland), Hamilton (Canada), Alicante (Spain), Monza (Italy), London (UK), Leuven (Belgium). Survival was estimated with Kaplan-Meier, and differences in survival were determined by log-rank analysis. We investigated pre-and post-operative prognostic factors using Cox proportional hazards regression model; multivariable analysis was performed only with variables, which were statistically significant at the invariable analysis. Results: A total of 136 patients were included in the study. Mean age was 73.8 years (SD 3.6). 24 patients (17.6%) had an induction treatment (chemotherapy alone in 15 patients and chemo-radiation in 9). Mean length of stay (LOS) was 12.6 days (SD 10.39) and 74 patients (54.4%) had experienced a post-operative complication: 29 (21.3%) had a pulmonary complication, 33 (24.3%) had a cardiac complication and in 12 cases (8.8%) patients experienced both cardiac and pulmonary complications. 16 patients were readmitted [median LOS 13.7 days (range, 2-39 days)] and of those 14 (10.3%) required redo surgery. Median overall survival (OS) of the entire cohort was 38 months (95% CI: 29.9-46.1 months); in-hospital mortality was 1.5%, 30-day mortality rate was 3.7%, while 90-day mortality was 8.8% accounting for 5 and 12 patients respectively. Patients receiving neo-adjuvant therapy did not experience a higher incidence of postoperative complications (P=0.633), did not have a longer postoperative course (P=0.588), nor did they have an increased mortality rate (P=0.863). Conclusions: Age should not be considered an absolute contraindication for pneumonectomy in elderly patients even after neoadjuvant treatment. It has become apparent that especially in these patients, a patient tailored approach with a careful selection should be used to define the risk-benefit balance.
Filiaciones:
Minervini, F:
Cantonal Hosp Lucerne, Dept Thorac Surg, Luzern, Switzerland
Kocher, G:
Univ Bern, Bern Univ Hosp, Div Thorac Surg, Bern, Switzerland
Bertoglio, P:
IRCSS Azienda Osped Univ, Div Thorac Surg, Bologna, Italy
Kestenholz, P:
Cantonal Hosp Lucerne, Dept Thorac Surg, Luzern, Switzerland
:
Univ Hosp Alicante, Dept Thorac Surg, Alicante, Spain
Patrini, D:
Univ Coll London Hosp, Dept Thorac Surg, London, England
Ceulemans, L:
Univ Hosp Leuven, Dept Thorac Surg, Leuven, Belgium
KULeuven, Lab BREATHE, Dept Chron Dis & Metab, Leuven, Belgium
Begum, H:
McMaster Univ, Dept Thorac Surg, Hamilton, ON, Canada
Lutz, J:
Univ Bern, Bern Univ Hosp, Div Thorac Surg, Bern, Switzerland
Shojai, M:
Univ Bern, Bern Univ Hosp, Div Thorac Surg, Bern, Switzerland
Shargall, Y:
McMaster Univ, Dept Thorac Surg, Hamilton, ON, Canada
Scarci, M:
San Gerardo Hosp, Dept Thorac Surg, Monza, Italy
Green Published, gold
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