VATS lobectomy outcomes in octogenarian patients: a retrospective series

The proportion of octogenarian patients is growing over years. Nowadays video-assisted thoracoscopic surgery (VATS) permits to treat old age patients, even with limited pulmonary function, not otherwise suitable for surgery. The aim of our study is to analyse the factors influencing short and long terms outcome of the octogenarian patients underwent VATS lobectomy. Between January 2013 and March 2019 we performed 292 VATS lobectomies of which 26 patients were octogenarian. The patients’ population were divided in two groups according to patient’s age (group 1: patient younger than 80 years old; group 2: older than 80 years old). The octogenarian patients had higher post-operative complication (POC) rate and hospital stay than the younger patients. Surgeon’s learning curve was significantly associated to higher POC in both group of patients (group 1: P<0.002, group 2: P<0.001). Patients of both groups who underwent VATS lobectomy performed by resident surgeon supported by a skilled tutor had a significantly lower risk of POC (group 1 and group 2: P<0.001). Right upper lobectomy was significantly associated to higher risk of POC in both groups (group 1: P<0.008, RR =1.7 and group 2: P<0.032, RR =1.5) whereas left lower lobectomy showed higher risk of POC only in group 1 (P<0.03, RR =1.9). Hospital stay was significantly influenced by POC (group 1: P<0.001, Group 2: P<0.03) and by post-operative atrial fibrillation in octogenarian group (P<0.04). Overall survival was influenced by lung cancer’s stage but not by age and POC in both groups. In conclusion octogenarian patients should undergo surgery after a completed pre-operative assessment due to their comorbidities. Post-operative outcome and overall survival of elderly patients are comparable with younger patients.