Advertisement

Thoracic Surgery in the Elderly

  • Maria D. Castillo
  • Jeffrey Port
  • Paul M. Heerdt
Chapter

Abstract

As the population ages, increasing numbers of elderly patients with present for thoracic surgery. Physiologic changes that occur with advanced age result in a decline of maximal reserves, affecting the patient’s ability to cope with the stress of surgery. Increased age is also associated with increased comorbidities. Elderly patients with cancer may still stand to benefit from surgery, since survival rates for lung and esophageal cancer are very low without surgical resection. Perioperative morbidity and mortality is more closely associated with preoperative health status and tumor stage than chronological age. Minimally invasive surgical techniques such as video-assisted thoracoscopic surgery (VATS) have been shown to be an effective approach for surgical resection of cancer. Because better postoperative pulmonary function, less postoperative pain, and fewer complications were shown for patients who underwent VATS compared to those who underwent thoracotomy for lobectomy, VATS may be a good choice for patients of advanced age due to their decreased physiologic reserves. Careful preoperative assessment and postoperative care are essential in this surgical population due to their diminished ability to handle the stress of surgery.

Keywords

Chronic Obstructive Pulmonary Disease Postoperative Delirium Postoperative Atrial Fibrillation Minimally Invasive Surgical Early Stage Lung Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1.  1.
    Yancik R. Population aging and cancer: a cross-national concern. Cancer J. 2005;11(6):437–41.PubMedCrossRefGoogle Scholar
  2.  2.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49.PubMedCrossRefGoogle Scholar
  3.  3.
    Hurria A, Kris MG. Management of lung cancer in older adults. CA Cancer J Clin. 2003;53(6):325–41. Review.PubMedCrossRefGoogle Scholar
  4.  4.
    Watters JM, McClaran JC, Man-Son-Hing M. The elderly ­surgical patient. In: ACS surgery principles and practice. New. York, NY: WebMD; 2005.Google Scholar
  5.  5.
    Sieber FE, Pauldine R. Geriatric anesthesia. In: Miller RD, ­editor. Anesthesia. Philadelphia: Churchill Livingstone; 2009.Google Scholar
  6.  6.
    Lakatta EG, Sollott SJ. Perspectives on mammalian cardiovascular aging: humans to molecules. Comp Biochem Physiol A Mol Integr Physiol. 2002;132(4):699–721.PubMedCrossRefGoogle Scholar
  7.  7.
    Castillo MD, Heerdt PM. Lung resection in the elderly. Curr Opin Anaesthesiol. 2007;20(1):4–9.PubMedCrossRefGoogle Scholar
  8.  8.
    Levitzky MG. Alveolar ventilation. McGraw-Hill: In Respiratory Physiology; 2007.Google Scholar
  9.  9.
    Epstein M. Aging and the kidney. J Am Soc Nephrol. 1996;7:1106–22.PubMedGoogle Scholar
  10. 10.
    Muhlberg W, Platt D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology. 1999;45(5):243–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Katznelson R, Djaiani GN, Borger MA, et al. Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery. Anesthesiology. 2009;110(1):67–73.PubMedCrossRefGoogle Scholar
  12. 12.
    Robinson TN, Raeburn CD, Tran ZV, et al. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249(1):173–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Neugut AI, Jacobson JS. Women and lung cancer: gender equality at a crossroad? JAMA. 2006;296(2):218–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Roth JA, Atkinson EN, Fossella F, et al. Long-term follow-up of patients enrolled in a randomized trial comparing preoperative chemotherapy and surgery with surgery alone in respectable stage IIIA non-small-cell lung cancer. Lung Cancer. 1998;21:1–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Takeda S, Maeda H, Okada T, et al. Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA-IIIB) lung cancer. Eur J Cardiothorac Surg. 2006;30(1):184–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosell R, Gomez-Codina J, Camps C, et al. Preresectional chemotherapy in stage IIIA non-small-cell lung cancer a 7-year assessment of a randomized controlled trial. Lung Cancer. 1999; 26:7–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Fujita S, Katakami N, Takahashi Y, et al. Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer. Eur J Cardiothorac Surg. 2006;29(6):896–901.PubMedCrossRefGoogle Scholar
  18. 18.
    Petersen RP, Pham D, Toloza EM, et al. Thoracoscopic lobectomy: a safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer. Ann Thorac Surg. 2006;82(1):214–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Ruol A, Portale G, Castoro C, et al. Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer. Ann Surg Oncol. 2007;14(11):3243–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Mery CM, Pappas AN, Bueno R, et al. Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the Surveillance, Epidemiology, and End Results Database. Chest. 2005;128:237–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Birim O, Zuydendorp HM, Maaat AP, et al. Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population. Ann Thorac Surg. 2003;76(6):1796–801.PubMedCrossRefGoogle Scholar
  22. 22.
    Ginsberg RJ, Hill LD, Eagan RT, et al. Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg. 1983;86:654–8.PubMedGoogle Scholar
  23. 23.
    Yamamoto K, Alarcon JP, Medina VC, et al. Surgical results of stage I non-small cell lung cancer: comparison between elderly and younger patients. Eur J Cardiothorac Surg. 2003;23(1):21–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Sullivan V, Tran T, Holmstrom A, et al. Advanced age does not exclude lobectomy for non-small cell lung carcinoma. Chest. 2005;128(4):2671–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Sawada S, Komori E, Nogami N, et al. Advanced age is not correlated with either short-term or long-term postoperative results in lung cancer patients in good clinical condition. Chest. 2005;128:1557–63.PubMedCrossRefGoogle Scholar
  26. 26.
    Hanagiri T, Muranaka H, Hashimoto M, et al. Results of surgical treatment of lung cancer in octogenarians. Lung Cancer. 1999;23(2):129–33.PubMedCrossRefGoogle Scholar
  27. 27.
    Wada H, Nakamura T, Nakamoto K, et al. Thirty-day operative mortality for thoracotomy in lung cancer. J Thorac Cardiovasc Surg. 1998;115:70–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006;244(3):420–5.PubMedGoogle Scholar
  29. 29.
    McKenna Jr RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1, 100 cases. Ann Thorac Surg. 2006;81(2):421–5.PubMedCrossRefGoogle Scholar
  30. 30.
    McVay CL, Pickens A, Fuller C, et al. VATS anatomic pulmonary resection in octogenarians. Am Surg. 2005;71(9):791–3.PubMedGoogle Scholar
  31. 31.
    Matsuoka H, Okada M, Sakamoto T, Tsubota N. Complications and outcomes after pulmonary resection for cancer in patients 80 to 89 years of age. Eur J Cardiothorac Surg. 2005;28(3):380–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Port JL, Kent M, Korst RJ, et al. Surgical resection for lung cancer in the octogenarian. Chest. 2004;126(3):733–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Brock MV, Kim MP, Hooker CM, et al. Pulmonary resection in octogenarians with stage I nonsmall cell lung cancer: a 22-year experience. Ann Thorac Surg. 2004;77(1):271–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Internullo E, Moons J. Nafteux, et al. Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg. 2008;33(6):1096–104.PubMedCrossRefGoogle Scholar
  35. 35.
    Perry Y, Fernando HC, Buenaventura PO, et al. Minimally invasive esophagectomy in the elderly. JSLS. 2002;6(4):299–304.PubMedGoogle Scholar
  36. 36.
    Nguyen NT, Hinojosa MW, Smith BR, et al. Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg. 2008;248(6):1081–91.PubMedCrossRefGoogle Scholar
  37. 37.
    Ruol A, Portale G, Zaninotto G, et al. Results of esophagectomy for esophageal cancer in elderly patients: age has little influence on outcome and survival. J Thorac Cardiovasc Surg. 2007;133(5):1186–92.PubMedCrossRefGoogle Scholar
  38. 38.
    Morita M, Egashira A, Yoshida R, et al. Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus. J Gastroenterol. 2008;43(5):345–51.PubMedCrossRefGoogle Scholar
  39. 39.
    Alibakhshi A, Aminian A, Misharifi R, et al. The effect of age on the outcome of esophageal cancer surgery. Ann Thorac Med. 2009;4(2):71–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Pagni S, McKelvey A, Riordan C, et al. Pulmonary resection for malignancy in the elderly: is age still a risk factor? Eur J Cardiothorac Surg. 1998;14(1):40–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Ventura SJ, Peters KD, Martin JA, et al. Births and deaths: United States, 1996. Mon Vital Stat Rep. 1997;46(1 Suppl 2):1.PubMedGoogle Scholar
  42. 42.
    McGarry RC, Song G, des Rosiers P, et al. Observation-only management of early stage, medically inoperable lung cancer: poor outcome. Chest. 2002;121:1155–8.Google Scholar
  43. 43.
    Flehinger BJ, Kimmel M, Melamed MR. The effect of surgical treatment on survival from early lung cancer: implications for screening. Chest. 1992;101:1013–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Furuta M, Hayakawa K, Katano S, et al. Radiation therapy for stage I-II non-small cell lung cancer in patients aged 75 years and older. Jpn J Clin Oncol. 1996;26:95–8.PubMedGoogle Scholar
  45. 45.
    Wiener DC, Argote-Greene LM, Ramesh H, et al. Choices in the management of asymptomatic lung nodules in the elderly. Surg Oncol. 2004;13(4):239–48. Review.PubMedCrossRefGoogle Scholar
  46. 46.
    Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993;56(6):1285–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Sugiura H, Morikawa T, Kaji M, et al. Long-term benefits for the quality of life after video-assisted thorascopic lobectomy in patients with lung cancer. Surg Laparosc Endosc Percutan Tech. 1999;9(6):403–8.PubMedGoogle Scholar
  48. 48.
    Jaklitsch MT, DeCamp MM, Liptay MJ, et al. Video-assisted thoracic surgery in the elderly. A review of 307 cases. Chest. 1996;110:751–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Schoppmann SF, Prager G, Langer F, et al. Fifty-five minimally invasive esophagectomies: a single centre experience. Anticancer Res. 2009;29(7):2719–25.PubMedGoogle Scholar
  50. 50.
    Braghetto I, Csendes A, Cardemil G, et al. Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival. Surg Endosc. 2006;20(11):1681–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Galvani CA, Goodner MV, Moser F, et al. Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc. 2008;22(1):188–95.PubMedCrossRefGoogle Scholar
  52. 52.
    Walker WS, Codispoti M, Soon SY, et al. Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothorac Surg. 2003;23(3):397–402.PubMedCrossRefGoogle Scholar
  53. 53.
    Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg. 2000;24(1):27–30.PubMedCrossRefGoogle Scholar
  54. 54.
    Kaseda S, Aoki T, Hangai N, Shimizu K. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg. 2000;70(5):1644–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Daniels LJ, Balderson SS, Onaitis MW, D’Amico TA. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer. Ann Thorac Surg. 2002;74(3):860–4.PubMedCrossRefGoogle Scholar
  56. 56.
    Thomas P, Doddoli C, Yena S, et al. VATS is an adequate oncological operation for stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2002;21(6):1094–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Ohtsuka T, Nomori H, Horio H, et al. Is major pulmonary resection by video-assisted thoracic surgery an adequate procedure in clinical stage I lung cancer? Chest. 2004;125(5):1742–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Gharagozloo F, Tempesta B, Margolis M, Alexander EP. Video-assisted thoracic surgery lobectomy for stage I lung cancer. Ann Thorac Surg. 2003;76:10009–15.CrossRefGoogle Scholar
  59. 59.
    Koizumi K, Haraguchi S, Hirata T, et al. Lobectomy by video-assisted thoracic surgery for lung cancer patients aged 80 years or more. Ann Thorac Cardiovasc Surg. 2003;9(1):14–21.PubMedGoogle Scholar
  60. 60.
    Kirby TJ, Mack MJ, Landreneau RJ, Rice TW. Lobectomy-­video-assisted thoracic surgery versus muscle-sparing thoracotomy: a randomized trial. J Thorac Cardiovasc Surg. 1995;109:997–1002.PubMedCrossRefGoogle Scholar
  61. 61.
    Cattaneo SM, Park BJ, Wilton AS, et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg. 2008;85(1):231–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Amar D, Zhang H, Heerdt PM, et al. Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein. Chest. 2005;128(5):3421–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Park BJ, Zhang H, Rusch VW, Amar D. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2007;133:775–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Colice GL, Shafazand S, Griffin JP, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidence-based clinical practice guidelines (2nd edition). College of Chest Physicians. Chest. 2007;132 (3 Suppl):161S–77.PubMedCrossRefGoogle Scholar
  65. 65.
    King MS. Preoperative evaluation of the elderly. J Am Board Fam Pract. 1991;4(4):251–8.PubMedGoogle Scholar
  66. 66.
    Pedoto A, Heerdt PM. Postoperative care after pulmonary ­resection: postanesthesia care unit versus intensive care unit. Curr Opin Anaesthesiol. 2009;22(1):50–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Aoki T, Yamato Y, Tsuchida M, et al. Pulmonary complications after surgical treatment of lung cancer in octogenarians. Eur J Cardiothorac Surg. 2000;18(6):662–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Maria D. Castillo
    • 1
  • Jeffrey Port
    • 2
  • Paul M. Heerdt
    • 3
  1. 1.Department of AnesthesiologyMt. Sinai College of MedicineNew YorkUSA
  2. 2.Department of Cardiothoracic SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer CenterWeill Medical College of Cornell UniversityNew YorkUSA

Personalised recommendations