• Akira Okada, Tatsuhiko Hirono, and Takehiro Watanabe.
• Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, 1-14-1 Masago, Nishi-ku, Niigata 950-2085, Japan. okd_90@yahoo.co.jp
• Gen Thorac Cardiovasc Surg. 2012 Feb 1;60(2):97-103.

PurposeCurative lobectomy and systematic lymph node dissection for lung cancer in elderly patients are often associated with increased risk of postoperative morbidity and decreased quality of life. Conversely, avoiding surgery may mean not curing the cancer. We retrospectively examined data on surgery for octogenarians with clinical stage I non-small-cell lung cancer (NSCLC) to assess the safety and prognosis for patients who underwent radical or limited surgery.MethodsSubjects comprised 44 octogenarians who underwent surgery for clinical stage I NSCLC from 1996 to 2008. Preoperative co-morbidities, surgical procedures, postoperative morbidity, and prognoses were compared between radical and limited surgery.ResultsA total of 14 patients (32%) underwent complete lobectomy and systematic lymph node dissection (radical surgery), and 30 patients (68%) underwent segmentectomy or wedge resection or limited lymph node dissection (limited surgery). No significant differences in preoperative clinicopathological features were seen between groups except that significantly more clinical stage IA patients were in the limited surgery group than in the radical group. Surgical time was significantly shorter with limited surgery. Frequencies of postoperative morbidity and recurrence were similar for each type of surgery. Overall and disease-specific 5-year survival rates did not differ significantly between groups.ConclusionLimited surgery is less invasive and is associated with the same prognosis as radical surgery for octogenarians with NSCLC. Limited surgery for this cohort thus appears reasonable to prevent postoperative morbidity, particularly for patients with poor pulmonary reserve.

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