Video-assisted thoracoscopic surgery in octogenarians

Octogenarians are heterogeneous and have an increasing population. As older adults, they are susceptible to various lung and pleura conditions, which may benefit from video-assisted thoracoscopic surgery (VATS). Common conditions affecting this patient population include benign and malignant diseases such as empyema, bullous emphysema, pneumothorax, and lung cancer. We aim to provide an up-to-date review of the feasibility and outcomes of VATS for various pathologies in octogenarians. The PubMed database was searched using the following keywords: octogenarians, elderly, VATS, empyema, and enhanced recovery after thoracic surgery (ERATS). We limited our search to the time period between 2010 and 2023 to provide the most recent data. Initially, the search yielded over 30 articles; 14 most pertinent articles were included in our review. We did not limit the articles based on study design or sample size. A review of the literature showed that octogenarians can tolerate VATS. Despite their decreased physiological reserve, age alone should not be used to deny the curative operations. Several components of enhanced recovery protocols after thoracoscopy are shown to improve outcomes regardless of patients' age. As an invasive treatment for various conditions, surgery may pose a specific challenge in the elderly population. Risk assessment, thorough preoperative workup, appropriate patient selection, and perioperative management are imperative for successful outcomes.