Although lung cancer can be detected at any age, the number of diagnoses in patients over the age of 80 is growing.1 In the literature, this population has been associated with a higher incidence of postoperative complications and greater mortality.2 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.3 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.

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 (P=.40), FEV1% (P=.41), ppoFEV1% (P=.23), FEV1/FVC (P=.23) and DLCO (P=.76) between the 2 patient groups (Table 1). In the control group, 9.94% (87 patients) underwent pneumonectomy, while this procedure was performed in 9.43% (5 patients) of cases (P=.90). Cardiorespiratory complications occurred in 112 controls (12.8%) and in 7 (13.21%) cases (OR: 1.03; 95% CI: 0.38–2.38) (Table 2). 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) (Table 3). In the logistic regression with resampling, ppoFEV1% was associated with postoperative complications (P<.005); age, however, was not (P=.12) (Table 4).

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.5 However, mortality associated with surgery increases proportionally with age,6 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.7 These latest mortality rates in octogenarian patients are similar to those obtained in our series.

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.8

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.9–12 This factor must be taken into account when discussing different treatment options with octogenarian patients, since many may choose a less invasive approach.13

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,14 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.

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.

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 2009.14 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.

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.

The authors state that they have no conflict of interests.