title: Thoracic surgery in octogenarians: CVTSA/Inova Fairfax hospital experience, 1990 to 2009.
abstract: With an increasing proportion of U.S. individuals 80 years of age or older, the authors examined their surgical experience with octogenarians undergoing major, curative-intent thoracic surgery. Between January 1, 1990, and September 1, 2009, 102 octogenarians underwent curative-intent resection for nonsmall cell carcinoma of the lung (NSCCL), esophageal carcinoma (EC), or related surgery for thoracic esophageal perforation (EP). Analysis and reporting followed the guidelines of the Nationwide Inpatient Sample database study (1994 to 2003). Eighty-six patients underwent curative-intent resection for NSCCL, 12 for EC, and four for surgery for EP. Hospital and 30-day mortalities were 0 per cent. Overall 1-, 2-, and 5-year survival rates were: 78, 58, and 32 per cent. Within the NSCCL cohort, minimally invasive exposures (video-assisted thoracic surgery [VATS] and video thoracoscopy [VT]) were associated with fewer and shorter duration of air leaks, leading to shorter length of stay. Since we began using minimally invasive exposure for NSCCL in 2007, the percentage of octogenarians discharged within 5 days of surgery has increased from 35.5 to 66.7 per cent (P = 0.01), and the percentage of patients discharged within 3 days of surgery has increased from 8.1 to 33.3 per cent (P = 0.006). Of 24 patients undergoing surgery for NSCCL since 2007, 18 (75%) underwent minimally invasive (VATS or VT) exposures, of which 15 patients (83.3%) were discharged home within 5 days and eight (44.4%) within 3 days of their procedure. Excellent, short- and longer-term results can be achieved in elderly patients if risks, exposures, and resections are appropriately matched to patient performance.
authors.affiliation: Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA. pdkkiernan@aol.com
authors.forename: Paul D
authors.initials: PD
authors.lastname: Kiernan
authors.forename: Sandeep J
authors.initials: SJ
authors.lastname: Khandhar
authors.forename: Daniel L C
authors.initials: DL
authors.lastname: Fortes
authors.forename: Keilla
authors.initials: K
authors.lastname: Schmidt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sheridan
authors.forename: Vivian
authors.initials: V
authors.lastname: Hetrick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004939:Esophageal Perforation / Q000601:surgery*; D016629:Esophagectomy / Q000706:statistics & numerical data; D005743:Gastrectomy / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends; D013908:Thoracotomy / Q000706:statistics & numerical data