Postoperative risks in septuagenarians undergoing VATS lobectomy

Abstract

Introduction: As the proportion of elderly thoracic patients is increasing, surgeons have often faced the need to perform anatomic lung resections despite the high comorbidity index. Aims: The aim of our study was to analyze the postoperative risks of septuagenarians undergoing VATS lobectomy. Methods: Retrospectively analyzed 188 patients submitted to VATS lobectomy for the past 4 years. 49 patients were older than 70 years (mean age 77±4,6 yrs, mean Charlson comorbidity index (CCI) 5,6±1.8), 139 were in a control group (mean age 57±10 yrs, mean CCI 2,7±2). The majority (92%) of elderly patients were diagnosed with primary lung cancer, others - benign lung diseases and metastasis. Among the control group lung cancer constituted 70,5%, others - tuberculosis, metastasis, and chronic abscesses. Complications assessed according to Ottawa classification system. Results: No perioperative mortality. 4 cases of reVATS. Complication rate in an elderly group 30,6% (80% - prolonged air leak, 13% - arrhythmias, 7% - prolonged effusion) and 33.1% - in a control group (63% - prolonged air leak, 9% - arrhythmias, 15% - prolonged effusion, 7% - atelectasis, 4% - re-operation and 2% - bladder tamponade), no significant difference between two groups, including grade 3 complications (p=0,56). Overall, the difference was not significant regarding volume of lymph node dissection (p=0,81), time of operation (p=0,49), blood loss (p=0,7) and length of stay (p=0,25). Two cases of blood transfusion in the septuagenarian group, and no cases in a control group, p=0,01. Conclusion: Advanced age is not an independent risk factor for VATS anatomic lung resection. Septuagenarians can undergo VATS lobectomy with acceptable postoperative risk.