Lobar Lung Resection in Elderly Patients With Non-Small Cell Lung Carcinoma: Impact of Chronic Obstructive Pulmonary Disease on Surgical Outcome

The aim of this study was to evaluate the impact of chronic obstructive pulmonary disease (COPD) on the perioperative morbidity and mortality after lobar lung resection for non-small cell lung cancer (NSCLC) in patients aged 70 years and older. The medical records of 73 patients ≥70 years who underwent lobar lung resection for NSCLC from 2003 to 2013 at our department were reviewed retrospectively. There were 27 patients with a mean age of 73.6 years and mean predicted forced expiratory volume in 1 s (FEV1) of 69.7% in the COPD group whereas remaining 46 patients (mean age = 75.6 years) in the non-COPD group had a mean predicted FEV1 of 79.1%. There were no significant differences in perioperative morbidity (4.8% in the COPD group versus 17.4% in the non-COPD group) between both groups. We had no perioperative mortality in both groups. Lobar lung resection for NSCLC seems to be a safe therapy option for elderly patients with COPD who are fulfilling the common functional criteria of operability so that radical surgery should remain the mainstay of treatment for early-stage NSCLC in this increasing subpopulation.Key words: Non-small cell lung carcinoma, Elderly, Lung resections, Chronic obstructive pulmonary diseaseWhile NSCLC is the leading cause of malignancy-related mortality in western countries,¹ COPD was reported to be the fifth leading cause of death worldwide in 2005, according to the World Health Organization (WHO).² Actually about 80 million people are suffering from COPD in the world and due to its rising incidence it is expected to be the third leading cause of death worldwide by 2020.^3,4 Incidence of both diseases diagnosed in the elderly people is rising due to increasing life expectancy. Demographic projections from the Federal Statistical Office of Germany indicate that by the year 2050 the number of citizens over 70 years will increase to 26.6% of the total population in Germany.⁵ It is generally accepted that elderly patients with non-small cell lung cancer (NSCLC) should not be excluded from curative resection only due to their chronological age as the operative results in this group are similar to that of younger patients.^6–11 The negative impact of COPD after pulmonary resections for NSCLC has been discussed in several studies, but the following question still remains to be answered: How fit are elderly patients with COPD for lobar lung resection?¹²⁻¹⁹The aim of this study was to evaluate the impact of COPD on operative morbidity and mortality in patients aged 70 years or older with NSCLC undergoing lobar lung resection.