title: Pneumonectomy for bronchogenic carcinoma in the elderly.
abstract: We have reviewed 70 consecutive elderly patients (70 years or older) who underwent pneumonectomy for bronchogenic carcinoma, in order to evaluate morbidity, mortality, and long-term survival. The majority of the patients had stage II (n = 32) or III (n = 25) disease. Fifteen deaths occurred in the peri-operative period (21%). Pre-operative factors associated with peri-operative death included a history of ischaemic heart disease (P = 0.001) and right-sided tumour (peri-operative mortality for right pneumonectomy = 37%, left pneumonectomy = 6%, P = 0.001). Poor lung function (as assessed by pre-operative spirometry), peripheral vascular disease, cerebrovascular disease, diabetes mellitus, and hypertension were not significant risk factors for peri-operative death. Post-operatively, the requirement for ventilation, or the development of post-operative myocardial infarction, adult respiratory distress syndrome and respiratory failure were significantly associated with peri-operative death. Over 60% of the patients developed one or more complications. The absolute survival rates for operative survivors were 51% and 27% at 1 and 5 years, respectively (stage I, 60% and 40%; stage II, 63% and 33%; stage III 33% and 14%). The absolute overall survival rates were 40% and 21% at 1 and 5 years, respectively. We conclude that pneumonectomy is justified in elderly patients but right-sided lesions and ischaemic heart disease should be considered as relative contra-indications.
authors.affiliation: Department of Thoracic Surgery, City Hospital, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Au
authors.forename: R
authors.initials: R
authors.lastname: el-Oakley
authors.forename: E W
authors.initials: EW
authors.lastname: Cameron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009017:Morbidity; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications; D015996:Survival Rate