Author of

• 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

  • 12513

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    P3.07-018 - <strong>Assessing Survival and Grading the Severity of Complications in Octogenarians Undergoing Pulmonary Lobectomy</strong> (ID 1685)

    09:30 - 09:30  |  Author(s): E.N. McKeown
    • Abstract

    Background
    Previous papers have demonstrated that pulmonary lobectomy on octogenarians is safe and feasible. However, there is little data characterizing the survival or the severity of complications in these frail patients after lobectomy. Therefore we reviewed our experience with patients aged eighty and above undergoing lobectomy.

    Methods
    We performed a retrospective review of consecutive patients aged 80 or above that underwent lobectomy between 2004 and 2012. Chart reviews were performed evaluating comorbidities, clinical stage, perioperative and postoperative course, time to recurrence, and date and cause of death. All complications were graded per the Seely Thoracic Surgery morbidity and mortality classification schema.

    Results
    45 patients (mean 82.2 years) underwent lobectomy. PFTs averaged 86% predicted for FEV1. Pathologic stage IA comprised 26% (10 of 39) of our patients; IB 33%(13), IIA 8% (3), IIB 8% (3), IIIA 18% (7), IIIB 3% (1), and IV 5% (2). Of the 45 patients, 28 had complications (60%), but only 18% (8 of 45) were significantly morbid to the patient (grade IIIB or above). Perioperative mortality was 2% (1 of 45). The most common complication was arrhythmia. Median LOS was 6 days for thoracotomy patients, 5.5 days for VATS patients, and 4.5 days for robot. 78% were discharged home, and 16% were readmitted to hospital within thirty days. Six patients had recurrent disease that occurred at an average of 768 days. 50% of our patients are still alive. Only three of the seven known causes of death were from metastatic disease. Five year actuarial survival was 52.3%. Mean survival was 53 months, and median survival was 72 months.

    Complications Separated by Grade

    Grade	Definition	Example	Incidence
    Grade I	Clinically Insignificant	Asymptomatic vocal cord paralysis, urinary retention	4% (2 of 45)
    Grade II	Medical Therapy Only	AFib, esophagitis, new home O2	26.7% (12 of 45)
    Grade IIIA	Interventions not requiring anesthesia	Percutaneous pleural catheters	13.3% (6 of 45)
    Grade IIIB	Interventions requiring anesthesia	Return to OR	8.8% (4 of 45)
    Grade IV	Critical illness, reintubation, organ failure	MI, PNA, chyle leak	6.7% (3 of 45)
    Grade V	Death		2.2% (1 of 45)

    Conclusion
    Lobectomy on carefully selected octogenarians can be done safely regardless of approach with a low mortality. 60% experienced a complication but when graded in a validated system only 18% were considered significant.