Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11610

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    P2.07-015 - Clinical outcome of 16 extremely elder patients (85-year-old or over) with surgically resected non-small cell lung cancer (ID 1364)

    09:30 - 09:30  |  Author(s): O. Kawamata
    • Abstract

    Background
    In Japan, an aging society, the number of surgical operations performed in the elderly has been increasing. In this study, to investigate whether the surgical resection of non-small cell lung cancer benefits extremely elder patients (85-year-old or over), we analyzed the clinical outcome of our patients.

    Methods
    Sixteen consecutive patients aged 85 years or older who underwent surgical resection of primary non-small cell lung cancer in our hospital from May 2002 to September 2012 were enrolled in this study. The patients’ operative procedure, respiratory function before operation, histological type, tumor size, clinical stage, comorbidity, surgery-related complications, prognosis, and recurrence were retrospectively reviewed.

    Results
    There were 11 males and 5 females. Their mean age was 86.6 years (range: 85-93 years). The mean follow-up period after operation was 1290 days (range: 249-4029 days). Operative procedures include lobectomy (N=4), segmentectomy (N=6), and wedge resection (N=6). Among them, thoracoscopic surgeries were performed in 14 patients. Patients treated by segmentectomy had poorer pulmonary function than others in terms of the forced expiratory volume in 1 second (FEV1.0) (mean±SD: 1.43±0.40 vs 1.94±0.39 L, p<0.05) and vital capacity (VC) (mean±SD: 2.02±0.51 vs 2.55±0.53 L, p=0.06). Histological type include adenocarcinoma (N=11) and squamous cell carcinoma (N=5). The tumor size ranged 11 mm to 48 mm. All 16 patients were negative for lymph node metastasis. Pathological stage was IA in 11 patients, IB in 4 patients, and IIB in 1 patient. Seven patients had comorbidity (e.g. COPD, post-bypass grafting for coronary aretery, and others). Seven patients were smokers. Mortality rate was 0% and morbidity rate was 25% (e.g. pulmonary fistula treated with pleurodesis in 1 patient, atrial fibrillation in 2 patients, heart failure in 1 patient, and delirium in 1 patient). Fourteen patients are alive, whereas 2 patients died from other diseases than lung cancer. The 2 patients died after 1950 days and 1344 days after operation, respectively. No patients had recurrence during the follow-up period.

    Conclusion
    No patients died from surgery or post-surgical complications. Our study indicates that the surgical resection of non-small cell lung cancer benefits patients, even with extremely elder age (85-year-old or over). For our institution’s principal indications for pulmonary surgery, patients with elder age (75-years-old or older) have to (i) be able to undergo pulmonary physiotherapy, (ii) have good performance status (0-1 in ECOG scale), and (iii) be free from psychological disorder such as dementia. Additionally, in cases with extremely older age (85-year-old or over), we consider patients with clinical stage I or patients without lymph node metastasis are good candidates. Lobectomy can be performed in patients with better pulmonary function, whereas patients with worse pulmonary function should undergo segmentectomy. Wedge resection is selected only if the lesion is judged to be completely resectable. We consider these inclusion criteria and the manner of selecting operative procedures will provide a good prognosis, even though the patient is 85 years or older.

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12503

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    P3.07-008 - Surgery of non-small cell lung cancer in the elderly, comparison between 75-79 years old cases and 80 years or older cases (ID 695)

    09:30 - 09:30  |  Author(s): O. Kawamata
    • Abstract

    Background
    Non-small cell lung cancer (NSCLC) is a typical disease of the elderly, and is becoming increasingly. Surgical resection is standard treatment for early-stage NSCLC. Our objective was to evaluate on surgery of NSCLC in the elderly, and assess the problem after surgical resection for NSCLC. We analyzed type of operation, postoperative complication, overall survival and cause of death for older patients undergoing surgical resection for NSCLC. We compare the clinical features of surgery of NSCLC in 75-79 years old patients and 80 years or older patients.

    Methods
    Of a total 140 patients aged 75 years or older who underwent surgery for NSCLC at our hospital between 2000 and 2012, there were classified into 75-79 years old and 80 years or older.

    Results
    Surgery of NSCLC in 75-79 years old and 80 or greater was 83 cases and 57 cases. 56(67.5%) patients in 75-79 years old and 36(63.2%) patients in 80 or greater were men. Adenocarcinoma constituted the most common pathologic subtype in two groups, 56(67.5%) cases in 75-79 years old, 42(73.7%) cases in 80 or greater. 55(66.3%) patients in 75-79 years old and 47(82.5%) patients in 80 or greater had stage IA/IB disease. 56(67.5%) patients in 75-79 years old and 32(56.1%) patients in 80 or greater underwent lobectomy. 19(22.9%) patients in 75-79 years old and 14(24.6%) in 80 or greater underwent segmentectomy. 7(8.4%) patients in 75-79 years old and 11(19.3%) in 80 or greater underwent wedge resection. Only one patient in 75-79 years old underwent pneumonectomy. Morbidity rate in 75-79 years old was 26.5%, and in 80 or greater was 22.8%. Atrial fibrillation was the most common postoperative complications in two groups. Mortality rate in 75-79 years old was 3.6%, and in 80 or greater was 3.5%. 30 patients in 75-79 years old and 12 patients in 80 or greater died within postoperative five years, 11 of 30 patients died for lung cancer and 19 patients died for the other illness. 15 of 19 patients were men, 3 of 15 were another organ cancer and 4 of 15 were respiratory failure. 6 of 12 patients died for lung cancer and other patients died for the other illness. Overall survival at 5 years in 75-79 years old was 58.5%, and in 80 or greater was 66.8%. Overall survival at 5 years in 75-79 years old male was 54.1%, and in female was 67.1%. Overall survival at 5 years in 80 or greater male was 68.6%, and in female was 64.3%. Overall survival at 5 years of stage IA in 75-79 years old was 80.8% and in 80 or greater was 78.7%.

    Conclusion
    Surgical resection of NSCLC in 75 years or older is permitted, especially in particular good indication for stage IA. However, long-term survival rate in 75-79 years old male was the poorest. The reason is that the ratio to die of the other illness was the highest. We thought that the decrease of the death by the other illness in 75-79 years old male is the most important.