Prevalence of and risk factors for pulmonary complications after lung cancer surgery in elderly patients with preserved lung function

Abstract

The prevalence of lung cancer in elderly patients is increasing. With improvements in surgical techniques and the physical performance of elderly patients, curative surgical resection is often considered a treatment option. However, it is necessary to identify the risk factors for postoperative pulmonary complications (PPCs) to select the optimal candidates for surgical resection in elderly patients with non-small cell lung cancer (NSCLC). This retrospective study examined the prevalence and risk factors for PPCs in elderly NSCLC patients with preserved pulmonary function.

A total of 496 patients who are older than 70 years with normal pulmonary function and underwent curative resection for NSCLC (clinical stage IA-IIB) from January 2012 to December 2016 were included.

The median age was 73 years and 48.6% were male. The prevalence of any PPC was 11.1%. Significantly more PPCs occurred in males (15.8% vs. 6.7%, p=0.001). In univariate analyses, male, low body mass index (BMI; <18.5), smoking history, American Society of Anesthesiologists (ASA) classification, surgical extent (bilobectomy or pneumonectomy), and an open approach were associated with PPCs. In multivariate analyses stratified by sex, low BMI (OR=4.79, 95% CI=1.52–15.11), ASA classification 3 (OR=3.86, 95% CI=1.13–13.25), and bilobectomy or pneumonectomy (OR=3.75, 95% CI=1.02–13.87) were significantly associated with PPCs in males, while no factors were significantly related to PPCs in females.

Sex, BMI, ASA classification, and surgical extent might help to identify elderly patients at risk of developing PPCs. Risk evaluations stratified by sex should be considered in a proper assessment.