Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer

Yunjoo Im,Sun Hye Shin,Sumin Shin,Ho Yun Lee,Hye Yun Park,Jhingook Kim,Insuk Sohn,Jong Ho Cho,Hong Kwan Kim,Young Mog Shim,Jae Ill Zo,Hyun Lee,Joong Hyun Ahn

doi:10.1186/s12931-019-1087-x

Abstract

Background and objectiveThe prevalence of lung cancer has been increasing in healthy elderly patients with preserved pulmonary function and without underlying lung diseases. We aimed to determine the prevalence of and risk factors for postoperative pulmonary complications (PPCs) in healthy elderly patients with non-small cell lung cancer (NSCLC) to select optimal candidates for surgical resection in this subpopulation.MethodsWe included 488 patients older than 70 years with normal spirometry results who underwent curative resection for NSCLC (stage IA-IIB) between 2012 and 2016.ResultsThe median (interquartile range) age of our cohort was 73 (71–76) years. Fifty-two patients (10.7%) had PPCs. Severe PPCs like acute respiratory distress syndrome, pneumonia, and respiratory failure had prevalences of 3.7, 3.7, and 1.4%, respectively. Compared to patients without PPCs, those with PPCs were more likely to be male and current smokers; have a lower body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification, more interstitial lung abnormalities (ILAs), and higher emphysema index on computed tomography (CT); and have undergone pneumonectomy or bilobectomy (all p < 0.05). On multivariate analysis, ASA classification ≥3, lower BMI, ILA, and extent of resection were independently associated with PPC risk. The short-term all-cause mortality was significantly higher in patients with PPCs.ConclusionsCurative resection for NSCLC in healthy elderly patients appeared feasible with 10% PPCs. ASA classification ≥3, lower BMI, presence of ILA on CT, and larger extent of resection are predictors of PPC development, which guide treatment decision-making in these patients.

Highlights

The median age at diagnosis of lung cancer is 70 years, [1] and more than 70% of future lung cancer cases are expected to occur in adults older than 65 years [2]
While decreased lung function is a major determinant for Postoperative pulmonary complication (PPC), and underlying lung diseases are associated with poorer surgical outcomes [9,10,11,12,13], healthy elderly patients with preserved lung function and no underlying lung diseases would be suitable candidates for surgery
We considered the following PPCs that occurred during hospitalization or readmission for 60 days postoperatively: pneumonia, acute respiratory distress syndrome (ARDS), respiratory failure, significant atelectasis requiring bronchoscopy or reintubation, bronchopleural fistula/empyema, prolonged air leakage lasting for more than 5 days, and pneumothorax [25]

Summary

Introduction

The median age at diagnosis of lung cancer is 70 years, [1] and more than 70% of future lung cancer cases are expected to occur in adults older than 65 years [2]. While decreased lung function is a major determinant for PPCs, and underlying lung diseases are associated with poorer surgical outcomes [9,10,11,12,13], healthy elderly patients with preserved lung function and no underlying lung diseases would be suitable candidates for surgery In this population, the evidence to decide the treatment strategy is still scant, when comparing the risks between postsurgical mortality/morbidity and lung cancer progression [14]. We aimed to determine the prevalence of and risk factors for postoperative pulmonary complications (PPCs) in healthy elderly patients with non-small cell lung cancer (NSCLC) to select optimal candidates for surgical resection in this subpopulation

Objectives

Methods

Results

Conclusion