Video-assisted thoracic surgery lobectomy for non-small cell lung cancer in patients with a Charlson comorbidity index score of two or more.
BACKGROUND
We evaluated the feasibility and safety of the video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) in patients with comorbidity.


METHODS
Between April 2000 and December 2006, a prospective database of 58 consecutive patients undergoing a VATS lobectomy for NSCLC, who had a Charlson comorbidity index score of 2 or more, was retrospectively analyzed. The demographic, perioperative, histopathologic, and outcome variables, including the recurrence and survival, were assessed.


RESULTS
The VATS lobectomy was successfully performed in 57 patients (16 women and 41 men; median age, 70 years). Twenty-three patients (40.4%) were aged 75 years or older. The total score of the Charlson comorbidity index was as follows: 2 in 26 patients, 3 in 13 patients, 4 in 12 patients, 5 in five patients, and 6 in one patient. None of the patients required a blood transfusion during surgery or during the postoperative course. We observed no intraoperative or in-hospital deaths, and no complications occurred in the 45 patients (78.9%). At a median follow-up of 34 months, a recurrence was observed in five patients who had advanced stages: a local recurrence in one and a distant recurrence in four. The overall 5-year survival rates for postoperative stage IA (n = 25) and IB (n = 16) were 100% and 94%, respectively.


CONCLUSIONS
We believe that a VATS lobectomy is a feasible and safe procedure for NSCLC in patients with comorbidity because this modality demonstrates an acceptable morbidity and a favorable oncologic outcome.
Nakanishi
Ryoichi
R
Department of Thoracic Surgery, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Kokurakita-ku, Kitakyushu, Japan. ryoichi@med.uoeh-u.ac.jp
Yamashita
Toshihiro
T
Oka
Soichi
S
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*