Resection rate and operability of elderly patients with non-small cell lung cancer: Nationwide study from 1991 to 2014.
An increasing number of elderly patients are diagnosed with non-small cell lung cancer (NSCLC). We compared the surgical resection rate, operability and survival in this age group (≥75 years) to younger patients using centralized databases in Iceland.



The study population comprised all patients diagnosed with NSCLC in Iceland from 1991 to 2014. A total of 140 elderly patients (≥75 years) with NSCLC underwent pulmonary resection and were compared with 550 surgically resected patients less than 75 years, with respect to resection rate, short and long-term survival and complications of surgery. Reasons for exclusion from surgery were registered for elderly surgical candidates (stages IA-IIB).



Surgical resection rate in the elderly group was 18% compared to 32% in the younger age group ( P <  0.001). The most frequent reasons for not operating on elderly patients in stages IA-IIB were poor pulmonary function (58%), heart disease (17%) or multiple comorbidities (17%). The rate of major complications following surgery was comparable in the elderly versus the younger age group, 13 vs 11%, respectively ( P =  0.578). The same was true for 30 day mortality (2 vs 1%, P =  0.397). Five-year overall survival was 40% vs 44% ( P =  0.019) and cancer-specific survival 51% vs 50% ( P =  0.802).



Elderly patients with resectable NSCLC according to stage are frequently excluded from surgery due to comorbid conditions. Although the operated patients may represent a selected group, their favourable 30-day and long-term survival indicate that more elderly patients with NSCLC could be operated on.
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Kristjan
K
Baldvinsson
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Gudrun Nina
GN
Oskarsdottir
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Andri Wilberg
AW
Orrason
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Hannes
H
Halldorsson
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Hunbogi
H
Thorsteinsson
Department of Anesthesiology, Brigham and Women's hospital, Boston, MA, USA.
Martin Ingi
MI
Sigurdsson
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.|Department of Pulmonology, Landspitali University, Reykjavik, Iceland.
Steinn
S
Jonsson
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.|Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Tomas
T
Gudbjartsson
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Elderly; Non-small cell lung cancer; Operability and survival; Resection rate