Surgical Management and Outcomes of Elderly Patients With Early Stage Non-small Cell Lung Cancer A Nested Case-Control Study

Background: The number of oncogeriatric patients with non-small cell lung cancer (NSCLC) is expected to increase in the next decades. Methods: We used the French Society of Thoracic and Cardiovascular Surgery database Epithor that includes information on >140,000 procedures from 98 institutions. We prospectively collected data from January 2004 to December 2008 on 1 969 patients aged >= 70 years with NSCLC stage I or II and matched them with 1,969 control subjects aged <70 years for sex, American Society of Anesthesia score, performance status, and FEV1. Surgical treatment and postoperative outcomes were compared between the two age groups. Results: The absence of radical lymphadenectomy was more frequent in the older patients (14%, n = 269) than in the younger patients (9%, n = 170) (P < .0001). There was no significant difference in type of resection between older and younger patients, respectively (pneumonectomy, 8% [n = 164] vs 11% [n = 216]; lobectomy, 79% [n = 1,559] vs 77% [n = 1,521]; bilobectomy, 4% [n = 88] vs 5% [n = 97]; sublobar resection, 7% [n = 143] vs 6% [n = 118]; P = .08). Differences in number (P = .07) and severity (P = .69) of complications were not significant. Postoperative mortality was higher in elderly patients at every end point (30-day mortality, 3.6% [n = 70] vs 2.2% [n = 43] [P = .01]; 60-day mortality, 4.1% [n = 80] vs 2.4% [n = 47] [P = .003]; 90-day mortality, 4.7% [n = 93] vs 2.5% [n = 50] [P = .0002]). Conclusions: Elderly patients with NSCLC should not he denied pulmonary resection on the basis of chronologic age alone. Among patients aged >= 70 years, 90-day mortality compared acceptably with mortality among younger matched patients. Additionally, the data show that for older patients, a 90-day mortality better represents their real mortality risk than 30- or 60-day figures. Our contemporary, multiinstitutional data importantly reveal that elderly patients, compared with their younger counterparts, do not have increased morbidity, incidence, or severity after pulmonary resection. CHEST 2011; 140(4):874-880