title: Efficacy of functional operability algorithm for octogenarians with primary lung cancer.
abstract: OBJECTIVE
  The number of lung cancer patients is increasing in association with the aging of society, and age is associated with the risk of undergoing a thoracotomy procedure. We prospectively investigated the efficacy of a functional operability algorithm that included pulmonary function and exercise test results for determining the indication for surgery in octogenarians.
  
  
  METHODS
  From April 2001 to October 2008, surgical indications for a total of 45 octogenarians were assessed using our algorithm, including forced expiratory volume in 1 s/forced vital capacity ratio, predicted postoperative percent of forced expiratory volume in 1 s, Hugh-Jones dyspneic index, and empirical anaerobic threshold obtained during an exercise test. Then the surgical results were reviewed.
  
  
  RESULTS
  Thoracotomy was contraindicated in one patient; the remaining 44 patients underwent surgery. Axilloanterior thoracotomy (75%), lobectomy (84%), and mediastinal lymph node dissection (73%) were the major procedures. Altogether, 37 postthoracotomy complica-Received: 13 February 2011 / Accepted: 30 May 2011 © The Japanese Association for Thoracic Surgery 2012 tions occurred in 29 (65.9%) patients. The 30-day and hospital mortality rates were 2.3% and 4.5%, respectively, and overall and disease-specific 5-year survival rates for the 42 patients were 54.5% and 79.6%, respectively.
  
  
  CONCLUSIONS
  Following careful selection with our functional operability algorithm, octogenarians were able to tolerate a standard lung resection for primary lung cancer with acceptable morbidity and mortality. Their survival was consistent with that of younger cancer patients.
authors.affiliation: Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Umezu
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Osamu
authors.initials: O
authors.lastname: Araki
authors.forename: Yohko
authors.initials: Y
authors.lastname: Karube
authors.forename: Motohiko
authors.initials: M
authors.lastname: Tamura
authors.forename: Satoru
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ishihama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Chida
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000465:Algorithms; D015308:Anaerobic Threshold; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008297:Male; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity