title: Risk analysis of pulmonary resection for elderly patients with lung cancer.
abstract: OBJECTIVE
  The indications for pulmonary resection in elderly patients with lung cancer concomitant with another disease are unclear. We conducted this retrospective study to establish the risk factors of complications and survival to improve patient selection.
  
  
  METHODS
  The subjects were 295 patients aged ≥ 75 years, who underwent pulmonary resection for lung cancer. We assessed comorbidity according to the Charlson comorbidity index (CCI) and examined risk factors for morbidity and the prognostic factors.
  
  
  RESULTS
  Postoperative complications developed in 55 patients (morbidity 18.6 %). The median survival time was 59.3 months and the 5-year survival rate was 69.7 %. Multivariate logistic regression analyses selected smoking and thoracotomy as risk factors for complications, and a history of cerebrovascular disease, cancer stage, and thoracotomy as risk factors for a prolonged hospital stay (PHS). Video-assisted thoracic surgery (VATS) decreased the risk of morbidity and PHS, and influenced survival. Multivariate analysis with the Cox proportional hazard model identified CCI ≥ 2, morbidity, and PHS as unfavorable survival factors, in addition to age ≥ 80 and cancers that were non-adenocarcinoma or advanced.
  
  
  CONCLUSIONS
  Although CCI ≥ 2 was associated with poorer survival, it was not necessarily a risk factor of postoperative complications or PHS. Performing VATS when possible could reduce the incidence of postoperative complications and PHS in elderly patients.
authors.affiliation: Department of Thoracic Surgery, Saku General Hospital, 197 Usuda, Saku, Nagano 384-0301, Japan. hid-end@showa.gunma-u.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Endoh
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Satoh
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nishizawa
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D011013:Pneumonectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012907:Smoking; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000401:mortality; D013908:Thoracotomy; D013997:Time Factors