Editorial
Morbidity, Mortality and Survival After Surgery for Lung Cancer
Morbilidad, mortalidad y supervivencia en las resecciones pulmonares en el carcinoma broncogénico
Jorge Freixinet Gilart
, Pedro Miguel Rodríguez Suárez
Corresponding author
Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Isla de Gran Canaria, Spain
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These procedures have undergone particular scrutiny in inter-departmental benchmarking processes, and auditing can provide a good indication of the quality of the unit.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> There are, however, certain interventions that can be controversial in special circumstances, some of which are addressed in the articles reviewed below.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2,3</span></a></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Lung Resection Surgery in Octogenarians</span><p id="par0010" class="elsevierStylePara elsevierViewall">Recent decades have seen a significant increase in the life expectancy of the population. In subjects over the age of 70, the incidence of lung cancer (LC) and consequent mortality is very high, and one of the most hotly debated issues in the surgical approach to these patients is whether age is a limiting factor for surgery. Specifically, the controversy centers on patients aged 80 or older. At this age, early stage LC diagnoses are common, and as such, many patients are candidates for surgery with curative intent. Although some authors working in the field have concluded that octogenarian patients undergoing lung resection have similar morbidity and mortality rates to the rest of the population,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2,4,5</span></a> elderly patients are obviously more frail. Some studies report higher mortality figures in patients of advanced age after major lung surgery, although the subject remains a matter for debate. The results of a study by Rodriguez et al. are consistent with others that found no differences in surgical risk associated with age: older and younger groups had similar postoperative cardiorespiratory complications and mortality.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4–6</span></a> However, significant differences were found in the logistical regression model for predicted postoperative FEV1% (ppoFEV1%), confirming that, as in the general population, resection of the least possible amount of lung parenchyma should be attempted to avoid postoperative complications and loss of quality of life.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Another very important question to bear in mind is the patients’ attitude toward surgery. Very few articles address this issue in depth, but in daily practice, we see that elderly patients do not approach their disease in the same way as younger ones, and they often question the real value of invasive surgery when their life expectancy is already limited. A joint discussion between the surgeon and patient is therefore essential, and must include a clear explanation of complications that can arise and expected postoperative quality of life. Screening of candidates for major lung resection must be particularly meticulous in the case of octogenarian patients.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> When surgery is proposed, video-assisted thoracoscopic resections may be an improvement in terms of postoperative complications and survival in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7,8</span></a> The alternative approach of sublobar resection or video-assisted thoracoscopic segmentectomy must also be considered where possible, as this procedure has shown some excellent results in stage I LC less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">9,10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pneumonectomy and Possible Alternatives</span><p id="par0020" class="elsevierStylePara elsevierViewall">The incidence of complications and postoperative mortality after pneumonectomy is high,<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">11,12</span></a> up to 3 times the risk of lobectomy. Postoperative problems mainly involve bronchopleural fistulas and cardiorespiratory complications.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> After the immediate postoperative stage, the intervention induces physiological changes that can significantly affect the pneumonectomized subject's quality of life and mortality, as reported in many studies, and in particular by Deslauriers et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a> It is interesting to compare pneumonectomy with lobectomy in stage IB LC. The skill and expertise of the surgeon may play a part in the surgical approach to these tumors. The future clinical course of a patient may depend on avoiding pneumonectomy, and opting for parenchyma-sparing techniques, such as angioplasty and bronchoplasty.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">14,15</span></a> An additional advance in this type of surgery has been the use of cryopreserved grafts. These procedures may be technically complex, but morbidity and mortality rates have not been higher in the series published to date.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> Indeed, as noted in the aforementioned article, the number of pneumonectomies carried out in a surgical unit decreases as surgeons acquire expertise.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless, there are occasions, such as infiltration of the hilar structures or interlobar extension, when pneumonectomy is unavoidable and lobectomy must be ruled out as a treatment option. In these cases, prognosis is poorer, due to both the intervention itself and tumor invasion across the fissure, which, in the opinion of some authors, suggests that the malignancy is more aggressive.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">17,18</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Pneumonectomy in Elderly Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">The second study we would like to discuss is related with the first, in that it addresses an issue also widely debated in the specialized literature: pneumonectomy in elderly patients. Older age, lower FEV1 and whole lung resection were factors for poorer survival and quality of life in the study reported by Rodríguez et al. This topic is of interest because several groups have explicitly advised against pneumonectomy in octogenarians,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> or have classified this procedure as very high risk.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> In these cases, then, the use of minimally invasive surgical techniques and alternatives to pneumonectomy also becomes more important, as discussed above.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0035" class="elsevierStylePara elsevierViewall">These studies have their limitations, including the lack of DLCO assessments in the early part of the series, the limited number of cases, and scant information on the indication for pneumonectomy. A multicenter approach could be of interest for addressing these questions, and could help to clarify some unresolved issues in LC surgery.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Lung Resection Surgery in Octogenarians" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Pneumonectomy and Possible Alternatives" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Pneumonectomy in Elderly Patients" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Freixinet Gilart J, Rodríguez Suárez PM. Morbilidad, mortalidad y supervivencia en las resecciones pulmonares en el carcinoma broncogénico. Arch Bronconeumol. 2015;51:211–212.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benchmarking in thoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Freixinet" 1 => "G. Varela" 2 => "L. Molins" 3 => "J.J. Rivas" 4 => "J.M. Rodríguez Paniauga" 5 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 52 | 19 | 71 |
| 2024 September | 56 | 16 | 72 |
| 2024 August | 59 | 37 | 96 |
| 2024 July | 52 | 26 | 78 |
| 2024 June | 64 | 24 | 88 |
| 2024 May | 69 | 43 | 112 |
| 2024 April | 43 | 23 | 66 |
| 2024 March | 34 | 14 | 48 |
| 2024 February | 33 | 27 | 60 |
| 2023 March | 9 | 4 | 13 |
| 2023 February | 42 | 20 | 62 |
| 2023 January | 50 | 24 | 74 |
| 2022 December | 48 | 35 | 83 |
| 2022 November | 66 | 30 | 96 |
| 2022 October | 48 | 40 | 88 |
| 2022 September | 43 | 29 | 72 |
| 2022 August | 77 | 44 | 121 |
| 2022 July | 49 | 35 | 84 |
| 2022 June | 45 | 32 | 77 |
| 2022 May | 110 | 36 | 146 |
| 2022 April | 84 | 32 | 116 |
| 2022 March | 94 | 41 | 135 |
| 2022 February | 88 | 36 | 124 |
| 2022 January | 105 | 39 | 144 |
| 2021 December | 81 | 48 | 129 |
| 2021 November | 87 | 43 | 130 |
| 2021 October | 83 | 41 | 124 |
| 2021 September | 65 | 50 | 115 |
| 2021 August | 65 | 32 | 97 |
| 2021 July | 72 | 17 | 89 |
| 2021 June | 102 | 32 | 134 |
| 2021 May | 97 | 26 | 123 |
| 2021 April | 187 | 56 | 243 |
| 2021 March | 145 | 19 | 164 |
| 2021 February | 107 | 21 | 128 |
| 2021 January | 94 | 8 | 102 |
| 2020 December | 91 | 14 | 105 |
| 2020 November | 109 | 16 | 125 |
| 2020 October | 85 | 11 | 96 |
| 2020 September | 88 | 11 | 99 |
| 2020 August | 86 | 14 | 100 |
| 2020 July | 86 | 19 | 105 |
| 2020 June | 68 | 3 | 71 |
| 2020 May | 66 | 12 | 78 |
| 2020 April | 67 | 20 | 87 |
| 2020 March | 67 | 15 | 82 |
| 2020 February | 83 | 16 | 99 |
| 2020 January | 79 | 21 | 100 |
| 2019 December | 109 | 17 | 126 |
| 2019 November | 111 | 36 | 147 |
| 2019 October | 82 | 11 | 93 |
| 2019 September | 69 | 16 | 85 |
| 2019 August | 67 | 19 | 86 |
| 2019 July | 70 | 21 | 91 |
| 2019 June | 64 | 13 | 77 |
| 2019 May | 63 | 14 | 77 |
| 2019 April | 135 | 22 | 157 |
| 2019 March | 87 | 20 | 107 |
| 2019 February | 73 | 22 | 95 |
| 2019 January | 101 | 20 | 121 |
| 2018 December | 97 | 22 | 119 |
| 2018 November | 117 | 23 | 140 |
| 2018 October | 137 | 34 | 171 |
| 2018 September | 93 | 12 | 105 |
| 2018 May | 36 | 0 | 36 |
| 2018 April | 98 | 6 | 104 |
| 2018 March | 108 | 9 | 117 |
| 2018 February | 82 | 9 | 91 |
| 2018 January | 60 | 12 | 72 |
| 2017 December | 58 | 7 | 65 |
| 2017 November | 66 | 10 | 76 |
| 2017 October | 76 | 9 | 85 |
| 2017 September | 66 | 13 | 79 |
| 2017 August | 63 | 24 | 87 |
| 2017 July | 88 | 12 | 100 |
| 2017 June | 84 | 16 | 100 |
| 2017 May | 84 | 14 | 98 |
| 2017 April | 87 | 14 | 101 |
| 2017 March | 103 | 12 | 115 |
| 2017 February | 126 | 8 | 134 |
| 2017 January | 108 | 15 | 123 |
| 2016 December | 70 | 17 | 87 |
| 2016 November | 53 | 11 | 64 |
| 2016 October | 37 | 18 | 55 |
| 2016 September | 36 | 19 | 55 |
| 2016 August | 37 | 13 | 50 |
| 2016 July | 32 | 29 | 61 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 44 | 4 | 48 |
| 2015 September | 34 | 3 | 37 |
| 2015 August | 51 | 22 | 73 |
| 2015 July | 2 | 2 | 4 |
| 2015 May | 2 | 0 | 2 |
| 2015 April | 2 | 0 | 2 |
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