title: Curative resection for lung cancer in octogenarians is justified.
abstract: BACKGROUND
  Due to an increased life expectancy in a healthy aging population and a progressive incidence of lung cancer, curative pulmonary resections can be performed even in octogenarians. The present study aims to investigate whether surgery is justified in patients reaching the age of 80 years and older who undergo resection for non-small cell lung cancer (NSCLC).
  
  
  METHODS
  In this retrospective multi-centre analysis, the morbidity, mortality and long-term survival of 88 patients (24 females) aged ≥80 who underwent complete resection for lung cancer between 2000 and 2013 were analysed. Only fit patients with few comorbidities, low cardiopulmonary risk, good quality of life and a life expectancy of at least 5 years were included.
  
  
  RESULTS
  Curative resections from three thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6 pneumonectomies and 12 segmentectomies or wide wedge resections with additional systematic mediastinal lymphadenectomy in all cases. Final histology revealed squamous cell carcinoma [33], adenocarcinoma [41], large cell carcinoma [5] or other histological types [9]. Lung cancer stage distribution was 0 [1], I [53], II [17] and IIIA [14]. The overall 90-day mortality was 1.1%. The median hospitalisation and chest drainage times were 10 days (range, 5-27 days) and 5 days (range, 0-17 days), respectively. Thirty-six patients were complication-free (41%). In particular, pulmonary complications occurred in 25 patients (28%). In addition, 23 patients (26%) developed cardiovascular complications requiring medical intervention, while 24 patients (27%) had cerebrovascular complications, urinary tract infection and others. The median survival time was 51 months (range, 1-110 months), and the 5-year overall survival reached 45% without significance between tumour stages.
  
  
  CONCLUSIONS
  Curative lung resections in selected octogenarians can be safely performed up to pneumonectomy for all tumour stages with a perioperative mortality, morbidity, and 5-year survival rate comparable to younger cohorts.
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michaela
authors.initials: M
authors.lastname: Tutic-Horn
authors.affiliation: Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Franco
authors.initials: F
authors.lastname: Gambazzi
authors.affiliation: Division of Thoracic Surgery, University Hospital Naples, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Monique
authors.initials: M
authors.lastname: Mosimann
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Opitz
authors.affiliation: Division of Thoracic Surgery, University Hospital Naples, Naples, Italy.
authors.forename: Nono
authors.initials: N
authors.lastname: Martucci
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland;; Department of Thoracic Surgery, Medical University Brandenburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Jungraithmayr
keywords: Lung cancer; octogenarians; resection; survival