THORACOTOMY IN PATIENTS OVER AGE 70 YEARS - 10-YEAR EXPERIENCE

Abstract

Recent reports demonstrate satisfactory long-term survival following pulmonary resection in the elderly. The high operative risk commonly cited in patients over 70 yr of age suggests that advanced age is a contraindication to pulmonary resection. During 1969 to 1978, 218 thoracotomies were performed in patients over the age of 70 yr. Operations performed include 175 pulmonary resections and 43 miscellaneous thoracic surgical procedures. Primary or metastatic cancer was the indication for 174 operations (pulmonary resection, 150 cases; exploration and biopsy, 16 cases; pleurectomy, 8 cases). Patients [137] (63%) had a benign course; 74 patients experienced 83 complications. Minor complications of atrial fibrillation, air leak persisting for 7-14 days and successfully managed retention of secretions were seen in 34 patients (16%). Nonfatal major complications were predominantly cardiac and respiratory in nature and occurred in 40 patients (18%). The overall hospital mortality was 3% (7 patients). Lung-sparing procedures were utilized whenever possible among the 150 patients undergoing pulmonary resection for carcinoma (sleeve lobectomy, 13 cases; segmental resection, 52 cases; wedge resection, 12 cases). The hospital mortality of 4% among these 150 patients was significantly lower (P < 0.001) than the 17% mortality among 308 elderly patients compiled from 5 series reported by other centers between 1973 and 1978. Long-term follow-up was obtained in 129 of the 139 (93%) available patients surviving pulmonary resection for cancer. The overall 5 yr survival rate is 27%, ranging from 13% for patients having pneumonectomy to 42% for those having segmental resection.