Surgery for bronchogenic carcinoma in the elderly.

Abstract

ample, a series of segmental or wedge resections in high risk patients resulted in a mortality rate of 1.5% and 5-year survival of 42% (6). Lest this experience be dismissed as nonrepresentative, con­ sider the experience of the Lung Cancer Study Group (LCSG) (8). This represents the work of numerous widely dispersed surgeons who achieved a mortality rate of 5.9% after pneumonectomies and 7.3% after lobectomies in patients over 70 years old. Although the operative risk for elderly LCSG patients was more than twice that for younger patients, the chance of older patients in the 1980s dy­ ing from thoractomies for BC appears to be less than the risk for younger pa­ tients during the 1960s and 1970s. Moreover, resections less than lobectomy now seem justifiable whenever suitable, at least in the elderly (9). We conclude that the risks of pulmonary resections in old patients are now within acceptable bounds, except when there are specific objective findings, which would also pre­ clude thoractomies in younger patients. The value of operations: It is axiomatic that complete staging is imperative in the elderly with BC; 35-40% of them will be found amenable to resection. Recent publications about older people report postoperative 2- and 5-year survival rates of 64% and 30%, respectively (4, 7). The actuarial 5-year survival of our own ex­ perience from 1978 to 1982 with 58 elderly BC patients was 35%. Although we cannot estimate the theoretical sur­ vival rate of elderly patients with resec­ table BC treated nonoperatively, availa­ ble evidence weighs heavily in favor of the value and safety of thoracotomies for treatment of well-selected elderly BC vic­ tims. Therapeutic nihilism is not defen­ sible. How should patients over 70 years old with BC, who need thoracotomies, be managed? Carefully and expertly! Avail­ able facts indicate that complete staging, careful and conservative operations, and well-tempered optimism are not only justified but indicated for the manage­ ment of well-selected elderly patients. Older people who suffer from BC deserve the opportunity for cure by resection.