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The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 187-193, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RH Breyer, C Zippe, WF Pharr, RJ Jensik, CF Kittle and LP Faber
Recent reports have demonstrated satisfactory long-term survival following
pulmonary resection in the elderly. However, the high operative risk
commonly cited in patients over 70 years of age has led some authors to
conclude that advanced age is a contraindication to pulmonary resection.
During 1969 to 1978, 218 thoracotomies were performed in patients over the
age of 70 years. Operations performed include 175 pulmonary resections and
43 miscellaneous thoracic surgical procedures. Primary or metastatic cancer
was the indication for 174 operations (pulmonary resection, 150 cases;
exploration and biopsy, 16 cases; pleurectomy, eight cases). One hundred
thirty-seven patients (63%) had a benign course, whereas 74 patients
experienced a total of 83 complications. Minor complications of atrial
fibrillation, air leaks persisting for 7 to 14 days, and successfully
managed retention of secretions were seen in 34 patients (16%). Nonfatal
major complications were predominantly cardiac and respiratory in nature
and occurred in 40 patients (18%). The overall hospital mortality was 3%
(seven patients). Lung-sparing procedures were utilized whenever possible
among the 150 patients undergoing pulmonary resection for carcinoma (sleeve
lobectomy, 13 cases; segmental resection, 52 cases; wedge resection, 12
cases). The hospital mortality of 4% among these 150 patients was
significantly lower (p < 0.001) than the 17% mortality among 308 elderly
patients compiled from five series reported by other centers between 1973
and 1978. Long-term follow-up was obtained in 129 of the 139 (93%)
available patients surviving pulmonary resection for cancer. The overall 5
year survival rate is 27%, ranging from 13% for patients having
pneumonectomy to 42% for those having segmental resection.
ARTICLES
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