Thoracic cancer surgery in the elderly

Our plain-English summary of Thoracic cancer surgery in the elderly, by J. Hasse, H. Wertzel, M. Kassa, et al (European Journal of Surgical Oncology, 1998).

The study

• Authors: J. Hasse, H. Wertzel, M. Kassa, G. Burgard
• Journal: European Journal of Surgical Oncology
• Published: 1998;24(5):403-6
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The risk of thoracic cancer surgery in patients of advanced age, i.e. 75 years or older, was analysed by reviewing 119 consecutive patients from August 1986 to May 1998 with bronchial carcinoma (n = 87), pulmonary metastases (n = 22), mesothelioma and pleural carcinosis (n = 7) and mediastinal or chest wall tumours (n = 3). Repeated surgery in one case of bronchial carcinoma and in another of metastases gave a total of 124 operations. Of the patients, 22 were 80 years or older (21%) and 32% were female. The median age was 77 years (range 75-87 years). Six fatalities occurred within 30 days or during hospitalization. This corresponds to a 4.8% mortality for the whole series and 6.8% for the subgroup of bronchial carcinoma. The causes of death were surgical complications in two patients, one died from heart failure after simultaneous combined coronary artery bypass grafting and left lower lobectomy 2 hours after the operation from heart failure refractory to resuscitation. With this exception all these patients had stage II (n = 2) or stage III A (n = 3) bronchial carcinoma. It is concluded that cancer surgery in the elderly is safe provided appropriate selection is observed. Indications should be very restrictive for advanced cancer and for pneumonectomy.

In plain English

This was a retrospective review of 119 consecutive patients aged 75 or older operated on for chest cancer at the University Hospital of Freiburg, Germany, between August 1986 and May 1998. Most had bronchial carcinoma (lung cancer, 87 patients). Twenty-two had pulmonary metastases, seven had mesothelioma or pleural carcinosis, and three had tumours of the mediastinum or chest wall. Repeat surgery brought the total to 124 operations. Twenty-two patients were octogenarians. The article did not study asbestos exposure and did not report results separately for the mesothelioma patients. Six patients died within 30 days or during their hospital stay. The article gave mortality as 4.8% for the whole series and 6.8% for bronchial carcinoma. These figures match six deaths among the 124 operations and among the 88 bronchial carcinoma operations. All six who died were men operated on for bronchial carcinoma. One died shortly after a combined heart bypass and lung lobectomy. The authors concluded that cancer surgery in the elderly is safe provided appropriate selection is observed. They added that indications should be very restrictive for advanced cancer and for pneumonectomy (removal of a whole lung).

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review (case series) of consecutive surgical patients at one hospital
• Who was studied: 119 consecutive patients aged 75 or older (median 77 years) operated on for malignant chest disease at the University Hospital of Freiburg, Germany, August 1986 to May 1998. Of these, 87 had bronchial carcinoma, 22 pulmonary metastases, 7 mesothelioma or pleural carcinosis, and 3 mediastinal or chest wall tumours. 35 were women and 22 were octogenarians.
• Exposure: No asbestos or other environmental exposure was studied. The 'exposure' was thoracic cancer surgery: 124 operations, including 4 pneumonectomies, 51 lobectomies, 25 segmental resections, 19 wedge resections and 12 tumour pleurectomies including mesothelioma.
• Main results:
  • Six patients died in hospital or within 30 days. The article gave a mortality of 4.8% for the whole series and 6.8% for the bronchial carcinoma subgroup. These percentages match six deaths among the 124 operations and among the 88 bronchial carcinoma operations, not six deaths among the 119 patients.
  • All patients who died were men operated on for bronchial carcinoma.
  • Two deaths were due to surgical complications. One patient died of heart failure after combined coronary artery bypass grafting and left lower lobectomy.
• The authors' conclusion: The authors concluded that cancer surgery in the elderly is safe provided appropriate selection is observed, and that indications should be very restrictive for advanced cancer and for pneumonectomy.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Mesothelioma, Pneumonectomy.

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