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Ann Thorac Surg 2003;76:1796-1801
© 2003 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
b Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
Accepted for publication June 13, 2003.
* Address reprint requests to Dr Kappetein, Department of Cardiothoracic Surgery, Room BD 156, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
e-mail: a.kappetein{at}erasmusmc.nl
BACKGROUND: Operative mortality and morbidity in elderly patients operated on for non–small-cell lung cancer are acceptable. However, risk factors for hospital mortality and the benefits for the patients in the long term are insufficiently defined, and survival compared with the general population is not known.
METHODS: From January 1989 to October 2001, 126 consecutive patients older than 70 years of age underwent resection for non–small-cell lung cancer. Each patient was scaled according to the Charlson Comorbidity Index. Postoperative events were divided into minor and major complications. Risk factors for complications and long-term survival were assessed by univariate and multivariate logistic regression analysis. Survival was compared with the yearly expected survival rates of the general population.
RESULTS: The hospital mortality was 3.2%. Minor complications occurred in 71 (57%) patients, major complications, in 16 (13%) patients. No risk factor was predictive for major complications. However, a Charlson comorbidity grade of 3 to 4 was predictive for major complications (odds ratio, 12.6; 95% confidence interval, 1.5 to 108.6). Our study showed a 5- and 10-year survival rate of 37% (95% confidence interval, 23 to 51) and 15% (95% confidence interval, 8 to 22). Smoking (odds ratio, 2.3), chronic obstructive pulmonary disease (odds ratio, 2.1), and pathologic stage IIIA (odds ratio, 2.2) or IIIB (odds ratio, 11.9) were risk factors for long-term survival. The observed survival was lower than the expected survival, but the difference decreased with increasing time after pulmonary resection.
CONCLUSIONS: Pulmonary resection for non–small-cell lung cancer in patients older than 70 years shows acceptable morbidity and mortality. The Charlson index is a better predictor of complications than individual risk factors. In time survival is no longer correlated with the disease but follows the same pattern as the general population.
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