Surgery for lung cancer in the elderly

Between January 1979 and December 1993, 162 patients aged more than 70 years underwent surgery for lung cancer. Thirty-eight patients (23%) were lost to follow-up. Overall median survival was 32 months. The overal five-year survival was 24% (Kaplan-Meier method). Age, histological type, stage and adjuvant treatments for stage IIIA were not significantly related to survival. Female sex (p = 0.03), and extent of resection (p = 0.02) significantly correlated to survival. Lobectomies were associated with a better survival than pneumonectomies (p = 0.03), the latter showing a better outcome than lesser resections (p = 0.03). The extent of resection was the only variable independently influencing the overall survival (p = 0.007). Median disease-free survival was 24 months. Female sex (p = 0.03) was the only independent predictor of disease-free survival by multivariate analysis (p = 0.02). Surgery for lung cancer in the elderly can be performed with acceptable long-term results in terms of overall and disease-free survival. The indications for pneumonectomy should be carefully weighed against potential postoperative risks. Even in the elderly patients, resections lesser than lobectomy, although functionally more acceptable, entail a greater risk for local recurrences.