Short- and long-term outcome of sleeve resections in the elderly

Objective: We evaluated the short- and long-term results of sleeve resections in a cohort of elderly patients with centrally located non-smallcell lung cancer. Methods: We retrospectively reviewed our prospective database of all patients aged >= 70 years who underwent sleeve resection for non-small-cell lung cancer. Clinical data, morbidity, mortality and survival were analysed. Results: Between January 1999 and December 2005, 31 consecutive patients (26 men) of a mean age of 72.8 +/- 2.4 years (range: 70-78 years) underwent bronchial (n = 21) and bronchovascular (n = 10) sleeve resections. A negative bronchial and vascular margin was achieved in all. No bronchial or vascular complications resulted. Morbidity and mortality were 41.9% and 6.2%, respectively. Calibre mismatch (p = 0.89), laterality (p = 0.22) and previous induction chemotherapy (p = 0.28) were not significantly related to morbidity. The overall 5-year survival rate was 56%. The nodal status did not influence the long-term survival in this study (p = 0.41). The type of sleeve resection (bronchial or bronchovascular) had no impact on survival (p = 0.62). Excessive dynamic airway collapse was associated with higher morbidity (p = 0.016) and poorer survival (p = 0.037). Conclusion: In the hands of experienced thoracic surgeons, bronchial and bronchovascular sleeve resections can be performed safely, even in elderly patients. Excessive dynamic airway collapse may be an important negative prognostic determinant of morbidity and mortality. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.