IBS03.02 Surgery for Elderly Patients with Stage III Non-Small-Cell Lung Cancer (NSCLC)?

Abstract

About 40% of the patients with newly diagnosed Non-small-Cell Lung cancer are between 65 to 75 years old and more than 15% are older than 75 years at the time of diagnosis. Elderly patients have in general a reduced cardiopulmonary performance status, including a higher risk for ischemic heart disease and COPD. Furthermore, higher co-morbidity can be expected (renal, metabolic, and cerebral). The major question whether surgery should be offered to patients of more than 70 years are whether there is a higher morbidity and mortality in elderly patients and the second question is, whether curative surgery approach is worthwhile in patients over 75 years. The question whether a higher age is associated with a higher morbidity in elderly patients has been investigated by different studies, most of them with a retrospective design. While in older studies from the 80-ies of last century (i.e. lung cancer study group) there was an elevated mortality in patients over 70 years, this was not true anymore in publications from the late 90th of last century and current publications: For example in a recent publication from the Japanese association of chest surgeons the postoperative mortality was 2 % in patients between 70 - 79 years old and it was 2.2 % in patients over 80 years old. Furthermore, there is only a little influence of the age with respect to the postoperative lung function parameters. If we try to analyze whether surgery is worthwhile in elderly patients, we have to realize that men who are now 85 years old have a mean life expectancy of 5.3 years and women of 6.3 years. Furthermore, there is no survival difference in surgically treated patients for stage III lung cancer which are younger or older than 70 years old. In a Japanese study, patients over 80 years have achieved a long term survival of more than 50 % after surgery for lung cancer. Limited resections can be successfully performed in patients with limited cardio pulmonary function parameters. In summary, the morbidity and mortality in elderly patients is not elevated after surgery and the median cancer specific long term survival is not different as compared to younger patients.