Original Article
Morbidity and Mortality in Octogenarians With Lung Cancer Undergoing Pneumonectomy
Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón
María Rodríguez, María Teresa Gómez Hernández, Nuria M. Novoa, José Luis Aranda, Marcelo F. Jiménez, Gonzalo Varela
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Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
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Novoa, José Luis Aranda, Marcelo F. Jiménez, Gonzalo Varela" "autores" => array:6 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Rodríguez" ] 1 => array:2 [ "nombre" => "María Teresa" "apellidos" => "Gómez Hernández" ] 2 => array:2 [ "nombre" => "Nuria M." "apellidos" => "Novoa" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "Aranda" ] 4 => array:2 [ "nombre" => "Marcelo F." "apellidos" => "Jiménez" ] 5 => array:4 [ "nombre" => "Gonzalo" "apellidos" => "Varela" "email" => array:1 [ 0 => "gvs.@usal.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Although lung cancer can be detected at any age, the number of diagnoses in patients over the age of 80 is growing.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> In the literature, this population has been associated with a higher incidence of postoperative complications and greater mortality.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> In studies in which the outcomes of anatomic resection in the elderly were similar to those obtained in younger patients, authors have attributed this similarity to more restrictive patient screening.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> In this study, we analyzed our population of octogenarian patients undergoing lung resection, evaluating 30-day mortality and morbidity. Finally, the characteristics of this population were compared with those of younger patients to determine if outcomes were related to more restrictive preoperative screening in octogenarians.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design</span><p id="par0010" class="elsevierStylePara elsevierViewall">Retrospective case-controlled study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study Population</span><p id="par0015" class="elsevierStylePara elsevierViewall">Patients consecutively scheduled for anatomic lung resection (protocolized segmentectomy, lobectomy, bilobectomy or pneumonectomy) due to lung cancer between January 2002 and December 2013 were included. Data were entered in a prospective database using two-pass verification as quality control. A total of 928 cases were analyzed.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patient Screening Criteria</span><p id="par0020" class="elsevierStylePara elsevierViewall">Before surgery, all patients underwent the same tests: physical examination, complete blood count and serum biochemistry, electrocardiogram, chest X-ray, computed tomography (CT) of the chest and abdomen, and bronchoscopy. PET–CT was performed in all patients included since 2007. Invasive mediastinal staging (by mediastinoscopy or endobronchial ultrasound since 2009) was performed if mediastinal lymphadenopathies >1<span class="elsevierStyleHsp" style=""></span>cm were seen on CT and if the mediastinal PET was positive. All patients performed lung function tests, including DLCO since 2009–this test was not routinely requested before then. Patients with suspected coronary disease or ECG suggestive of coronary changes were evaluated with ergometry or stress echocardiogram.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients were selected for surgery on the basis of absence of other comorbidities more severe than lung cancer and predicted postoperative FEV1>30% greater than predicted FEV1 for their age, sex and height, and after the case had been individually discussed by a multidisciplinary committee.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Perioperative Procedures</span><p id="par0030" class="elsevierStylePara elsevierViewall">Perioperative management of all study patients was the same, and has been described in detail in earlier publications.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> The surgical approach in all cases was muscle-sparing posterior thoracotomy, or either video-assisted or non-video-assisted axillary thoracotomy. The same group of anesthetists and thoracic surgeons were responsible for all anesthetic and surgical procedures, respectively. Antibiotic prophylaxis consisted of a single dose of 1500<span class="elsevierStyleHsp" style=""></span>mg cefuroxime that could be repeated if surgery was prolonged. Patients were extubated before they left the operating room, and after a few hours in the reanimation unit were transferred to the thoracic surgery ward. Bupivacaine and fentanyl were administered as postoperative analgesia via a thoracic epidural catheter for the first 3 days, followed by oral ibuprofen and paracetamol.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nursing care and physiotherapy were the same for all patients.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Variables Analyzed</span><p id="par0040" class="elsevierStylePara elsevierViewall">Independent variables included were age (as a binary variable: older or younger than 80 years), body mass index (BMI), FEV1%, predictive postoperative FEV1% based on the number of non-obstructed lung segments to be removed (ppoFEV1%), FEV1/FVC ratio, DLCO, and pneumonectomy rate. Dependent variables were postoperative cardiorespiratory complications (defined in previous studies<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a>; in short, postoperative onset arrhythmia, nosocomial pneumonia and postoperative atelectasis) and mortality at 30 days or at any time before hospital discharge.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The population was divided into 2 groups: octogenarians at time of intervention (cases) and patients younger than 80 (controls). Surgical risk variables were compared using the Wilcoxon test for continuous variables and the Chi-squared test for pneumonectomy rate. To evaluate the association between age group and 30-day mortality or morbidity, the odds ratio and the 95% confidence interval were calculated from 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2 tables. A logistic regression model with bootstrap resampling was constructed with 50 replicates, including age and ppoFEV1% as independent variables, and postoperative complications, including intraoperative death, as the dependent variable. Data were analyzed using Stata SE 12.1 software (StataCorp, TX, USA).</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Between January 2002 and December 2013, a total of 928 anatomic lung resections were performed for lung cancer (36 segmentectomies, 736 lobectomies, 64 bilobectomies and 92 pneumonectomies). Of these, 875 were performed in patients younger than 80 years and 53 in patients aged 80 years or more. The median age of the octogenarian group was 80 years (range: 80–86). With regard to surgical risk variables, no differences were found in BMI (<span class="elsevierStyleItalic">P</span>=.40), FEV1% (<span class="elsevierStyleItalic">P</span>=.41), ppoFEV1% (<span class="elsevierStyleItalic">P</span>=.23), FEV1/FVC (<span class="elsevierStyleItalic">P</span>=.23) and DLCO (<span class="elsevierStyleItalic">P</span>=.76) between the 2 patient groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In the control group, 9.94% (87 patients) underwent pneumonectomy, while this procedure was performed in 9.43% (5 patients) of cases (<span class="elsevierStyleItalic">P</span>=.90). Cardiorespiratory complications occurred in 112 controls (12.8%) and in 7 (13.21%) cases (OR: 1.03; 95% CI: 0.38–2.38) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Mortality in patients younger than 80 was 1.26% (11 patients), while 1 patient in the octogenarian group died (1.85%; OR: 1.48; 95% CI: 0.03–10.55) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). In the logistic regression with resampling, ppoFEV1% was associated with postoperative complications (<span class="elsevierStyleItalic">P</span><.005); age, however, was not (<span class="elsevierStyleItalic">P</span>=.12) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The number of cancer diagnoses in octogenarian patients is growing. Up to 87% of these are early-stage, so anatomic resection remains the best treatment option.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> However, mortality associated with surgery increases proportionally with age,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> and rates of up to 8.1% have been reported in some earlier studies, compared to 1.3% in the under-60 population, 4.1% in the 60–69 age group, and 7% in patients aged from 70 to 79. In more recent series, mortality after lobectomy in patients older than 75 was significantly higher than in patients younger than 75 (1.5% versus 0.3%, respectively), although figures remain low enough to continue to recommend lung resection in this population.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> These latest mortality rates in octogenarian patients are similar to those obtained in our series.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite data supporting lung resection in the elderly, attitudes to surgical risk and the concept of therapeutic success differ between octogenarian and younger patients. Many are concerned about complications that could prolong hospital stay or persist after discharge. For others, long-term survival is of less importance than relief of symptoms and maintaining a quality of life similar to that experienced before the procedure.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Although the prevalence of postoperative complications in our series was around 13%, in most other studies, 20%–60% of patients over 80 years had 1 or more postoperative complication, mainly cardiorespiratory events.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9–12</span></a> This factor must be taken into account when discussing different treatment options with octogenarian patients, since many may choose a less invasive approach.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Careful screening of surgical candidates, whether octogenarians or younger patients, has contributed to improved outcomes after anatomic lung resection. Appropriate selection of patients of all ages, based on published clinical guidelines,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> is essential for achieving satisfactory surgical outcomes and for reducing postoperative complications. Standardized patient screening, with discussion of each individual case by a multidisciplinary committee, would explain why the surgical risk variables presented by the octogenarian population in our hospital were similar to those of the younger population.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In our series, logistic regression analysis of the influence of age on the appearance of postoperative complications found no significant differences between the 2 patient groups. However, the influence of ppoFEV1% was statistically significant. This relationship would support the hypothesis that the more functional parenchyma removed, the more the patient's functional capacity and quality of life is compromised.</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study has some limitations: (1) screening bias, since we have no data on patients from either study group who were not referred for thoracic surgery for whatever reasons, and (2) DLCO was not routinely recorded in our database until 2009.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> Therefore, despite this test being one of the main determinants for surgical risk, we could not include it as an independent variable in our regression model. We are aware that the number of patients included in the octogenarian group is small, and that the study has other limitations typical of a retrospective study, but the information was retrieved from a prospective, double entry database, thus limiting considerably the risk of data bias. We are equally aware that our results cannot be generally extrapolated to those obtained by other researchers working with different methodologies.</p><p id="par0085" class="elsevierStylePara elsevierViewall">To conclude, our series shows that 30-day mortality and the risk of cardiorespiratory complications in octogenarian patients are similar to those of younger patients, and that this similarity in outcome is not due to a more restrictive selection of patients aged over 80 years, but rather to the careful screening of all candidates for surgery, irrespective of age. These data may contribute to therapeutic decision-making in patients older than 80, while bearing in mind the specific peculiarities of this group of patients and the findings of the different working groups.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of Interests</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres484704" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Study population" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec506937" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres484705" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec506936" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study Population" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Patient Screening Criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Perioperative Procedures" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Variables Analyzed" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Data Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-24" "fechaAceptado" => "2014-07-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec506937" "palabras" => array:4 [ 0 => "Pulmonary neoplasms" 1 => "Pneumonectomy" 2 => "Elderly" 3 => "Surgical risk" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec506936" "palabras" => array:4 [ 0 => "Neoplasias pulmonares" 1 => "Neumonectomía" 2 => "Ancianos" 3 => "Riesgo quirúrgico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case-controlled retrospective analysis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Study population</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No statistically significant differences were found in BMI (<span class="elsevierStyleItalic">P</span>=.40), FEV1% (<span class="elsevierStyleItalic">P</span>=.41), postoperative FEV1% (<span class="elsevierStyleItalic">P</span>=.23), FEV1/FVC (<span class="elsevierStyleItalic">P</span>=.23), DLCO (<span class="elsevierStyleItalic">P</span>=.76) and pneumonectomy rate (<span class="elsevierStyleItalic">P</span>=.90). Case mortality was 1.85% and control mortality was 1.26% (OR: 1.48). Cardiorespiratory complications occurred in 12.80% of younger subjects and in 13.21% of patients aged 80 years or older. (OR: 1.03). In the logistic regression, only FEV1% was related to postoperative complications (<span class="elsevierStyleItalic">P</span><.005).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Selection criteria for octogenarians are similar to those applied in the rest of the population. Advanced age is not a factor for increased 30-day mortality or postoperative morbidity.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Study population" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Valorar si los criterios de selección para resección pulmonar por cáncer son más estrictos en pacientes octogenarios que en el resto de la población. Comparar la mortalidad a 30 días y la morbilidad posquirúrgica en los 2 grupos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Método</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de casos y controles. La población se ha dividido en pacientes octogenarios (casos) o de menor edad (controles). Se han comparado las variables determinantes del riesgo quirúrgico (IMC, FEV1%, FEV1ppo%, FEV1/FVC, DLCO y tasa de neumonectomías) mediante la prueba de Wilcoxon o la prueba de Chi.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> Se han calculado las <span class="elsevierStyleItalic">odds ratio</span> en tablas 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2. Además, se ha construido un modelo de regresión logística con remuestreo, introduciendo como variable dependiente la presencia de complicaciones y como variables independientes edad y FEV1ppo%. La información se recuperó de una base de datos prospectiva.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">No se encontraron diferencias significativas en cuanto a IMC (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,40), FEV1% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,41), FEV1ppo% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,23), FEV1/FVC (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,23), DLCO (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,76) ni porcentaje de neumonectomías (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,90) entre los 2 grupos de pacientes. La mortalidad en los casos fue 1,85% y en los controles 1,26% (OR: 1,48). La prevalencia de complicaciones cardiorrespiratorias fue 12,80% en menores de 80 años y de 13,21% entre los octogenarios (OR: 1,03). En la regresión logística solo el FEV1% se relacionó con la aparición de complicaciones (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,005).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los criterios de selección de pacientes octogenarios son similares a los del resto de la población estudiada. Tener 80 o más años no se asocia con la mortalidad de la resección pulmonar a 30 días ni con la morbilidad analizada.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Rodríguez M, Gómez Hernández MT, Novoa NM, Aranda JL, Jiménez MF, Varela G. Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón. Arch Bronconeumol. 2015;51:219–222.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.40<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.41<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ppoFEV1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.23<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1/FVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.23<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">DLCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.76<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pneumonectomy rate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.90<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767374.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Wilcoxon test.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Chi-squared.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of Dependent Variables Between the 2 Populations.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Exposed (octogenarians with complications) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Not exposed (non-octogenarians with complications) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Octogenarians (cases) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Less than 80 years (controls) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">763 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">809 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">875 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">928 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Odds ratio: 1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95% CI: 0.38–2.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767373.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiorespiratory Complications.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Exposed (octogenarians with complications) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Not exposed (non-octogenarians with complications) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Octogenarians (cases) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Less than 80 years (controls) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">863 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">809 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">874 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">928 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Odds ratio: 1.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95% CI: 0.03–10.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767375.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mortality.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Number of observations<span class="elsevierStyleHsp" style=""></span>=928.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Replicates<span class="elsevierStyleHsp" style=""></span>=50.</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Wald Chi-squared<span class="elsevierStyleHsp" style=""></span>=21.76.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Prob<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>Chi-squared<span class="elsevierStyleHsp" style=""></span>=0.0000.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Pseudo <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>=0.05.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Coefficient observed \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bootstrap error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">z</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.006 to 0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ppoFEV1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.05 to 0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Constant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.191 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−4.09 to 0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767372.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Logistic Regression Model.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of lung cancer in older adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 46 | 16 | 62 |
| 2024 September | 36 | 12 | 48 |
| 2024 August | 55 | 26 | 81 |
| 2024 July | 42 | 19 | 61 |
| 2024 June | 46 | 29 | 75 |
| 2024 May | 74 | 28 | 102 |
| 2024 April | 32 | 27 | 59 |
| 2024 March | 29 | 16 | 45 |
| 2024 February | 35 | 21 | 56 |
| 2023 March | 4 | 1 | 5 |
| 2023 February | 34 | 21 | 55 |
| 2023 January | 19 | 31 | 50 |
| 2022 December | 37 | 28 | 65 |
| 2022 November | 69 | 29 | 98 |
| 2022 October | 48 | 30 | 78 |
| 2022 September | 24 | 46 | 70 |
| 2022 August | 35 | 42 | 77 |
| 2022 July | 28 | 34 | 62 |
| 2022 June | 19 | 33 | 52 |
| 2022 May | 30 | 31 | 61 |
| 2022 April | 16 | 31 | 47 |
| 2022 March | 30 | 33 | 63 |
| 2022 February | 29 | 32 | 61 |
| 2022 January | 24 | 30 | 54 |
| 2021 December | 21 | 38 | 59 |
| 2021 November | 33 | 43 | 76 |
| 2021 October | 35 | 39 | 74 |
| 2021 September | 25 | 42 | 67 |
| 2021 August | 23 | 36 | 59 |
| 2021 July | 22 | 28 | 50 |
| 2021 June | 37 | 42 | 79 |
| 2021 May | 29 | 26 | 55 |
| 2021 April | 136 | 44 | 180 |
| 2021 March | 51 | 19 | 70 |
| 2021 February | 46 | 16 | 62 |
| 2021 January | 42 | 15 | 57 |
| 2020 December | 35 | 11 | 46 |
| 2020 November | 30 | 13 | 43 |
| 2020 October | 11 | 19 | 30 |
| 2020 September | 17 | 17 | 34 |
| 2020 August | 28 | 9 | 37 |
| 2020 July | 19 | 21 | 40 |
| 2020 June | 20 | 9 | 29 |
| 2020 May | 21 | 14 | 35 |
| 2020 April | 28 | 27 | 55 |
| 2020 March | 22 | 12 | 34 |
| 2020 February | 29 | 19 | 48 |
| 2020 January | 24 | 17 | 41 |
| 2019 December | 29 | 23 | 52 |
| 2019 November | 22 | 22 | 44 |
| 2019 October | 27 | 11 | 38 |
| 2019 September | 20 | 13 | 33 |
| 2019 August | 24 | 11 | 35 |
| 2019 July | 28 | 21 | 49 |
| 2019 June | 24 | 21 | 45 |
| 2019 May | 29 | 8 | 37 |
| 2019 April | 36 | 35 | 71 |
| 2019 March | 30 | 28 | 58 |
| 2019 February | 31 | 19 | 50 |
| 2019 January | 31 | 14 | 45 |
| 2018 December | 42 | 24 | 66 |
| 2018 November | 60 | 18 | 78 |
| 2018 October | 95 | 29 | 124 |
| 2018 September | 50 | 8 | 58 |
| 2018 May | 12 | 0 | 12 |
| 2018 April | 24 | 6 | 30 |
| 2018 March | 34 | 4 | 38 |
| 2018 February | 39 | 8 | 47 |
| 2018 January | 132 | 5 | 137 |
| 2017 December | 127 | 6 | 133 |
| 2017 November | 21 | 4 | 25 |
| 2017 October | 28 | 6 | 34 |
| 2017 September | 14 | 3 | 17 |
| 2017 August | 17 | 7 | 24 |
| 2017 July | 19 | 11 | 30 |
| 2017 June | 40 | 16 | 56 |
| 2017 May | 29 | 7 | 36 |
| 2017 April | 24 | 11 | 35 |
| 2017 March | 26 | 4 | 30 |
| 2017 February | 16 | 6 | 22 |
| 2017 January | 11 | 3 | 14 |
| 2016 December | 32 | 7 | 39 |
| 2016 November | 36 | 13 | 49 |
| 2016 October | 42 | 7 | 49 |
| 2016 September | 43 | 7 | 50 |
| 2016 August | 39 | 11 | 50 |
| 2016 July | 35 | 13 | 48 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 46 | 1 | 47 |
| 2015 September | 32 | 12 | 44 |
| 2015 August | 47 | 17 | 64 |
| 2015 July | 1 | 1 | 2 |
| 2015 June | 0 | 1 | 1 |
| 2015 May | 0 | 3 | 3 |
| 2015 April | 3 | 0 | 3 |
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