Abstract
The majority of pulmonary surgery is performed for lung cancer, which is a disease of older adults. The median age of diagnosis of lung cancer in the United States is 71 years and over 65% of patients are diagnosed after age 65. Importantly, the decision to treat this cancer surgically should not be based on chronologic age alone, but on physiologic factors and a patient’s personal goals of care.
Physiologic changes of normal aging include decreased chest wall compliance and strength, increased residual volume and functional residual capacity, and an attenuated response to both hypoxemia and hypercapnia. Therefore, preoperative evaluation must include, in addition to routine assessment of cardiac and renal function, an evaluation of respiratory capacity; this can range from basic spirometry to full cardiopulmonary stress testing and quantitative ventilation/perfusion scanning. Geriatric assessments of cognition, frailty, function, and nutrition should be added.
Operative risk in the older adult is largely attributable to loss of functional lung tissue and pain/stress of the thoracic surgical approach. There is growing evidence that minimally invasive surgery is beneficial in the older adult. Limited resections such as segmentectomy or wedge resection, compared to formal lobectomy, should be considered a compromise treatment but are acceptable in the older adult with major morbidity or shorter expected life span. Resection should also be considered for pulmonary carcinoid and pulmonary metastases.
Specialized multidisciplinary postoperative care and attention to detail perioperatively holds great benefit for the older adult thoracic surgery patient.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
US Census Bureau, Population Division. Table 3. Projections of the population by sex and selected age groups for the United States: 2015 to 2060 (NP2014-T3) Release Date: December 2014
US Census Bureau, Population Division. Table 6. Percent distribution of the projected population by selected age groups for the United States: 2015 to 2060 (NP2014-T6). Release Date: December 2014
Arias E, Heron M, Xu JQ (2017) United States life tables, 2014. In: National vital statistics reports, vol 66, no 4. National Center for Health Statistics, Hyattsville
US Census Bureau, Population Division. Table 17. Projected life expectancy at birth by sex, race, and Hispanic origin for the United States: 2015 to 2060 (NP2014-T17). Release Date: December 2014
American Cancer Society, Cancer Facts & Figures (2017) Age-adjusted cancer death rates, males by site. http://www.cancer.org/docroot/MED/content/MED_1_1_Most_Requested_Graphs_and_Figures_2008.asp
American Cancer Society, Cancer Facts & Figures (2017) Age-adjusted cancer death rates, females by site. http://www.cancer.org/docroot/MED/content/MED_1_1_Most_Requested_Graphs_and_Figures_2008.asp
Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975–2014. National Cancer Institute. Bethesda. https://seer.cancer.gov/csr/1975_2014/. Based on November 2016 SEER data submission, posted to the SEER web site, April 2017
Gridelli C, Langer C, Maione P, Rossi A, Schild SE (2007) Lung cancer in the elderly. J Clin Oncol 25(14):1898–1907
Hage R, de la Riviere AB, Seldenrijk C, van den Bosch JM (2003) Update in pulmonary carcinoid tumors: a review article. Ann Surg Oncol 10(6):697–704
Teeter SM, Holmes FF, McFarlane MJ (1987) Lung carcinoma in the elderly population. Influence of histology on the inverse relationship of stage to age. Cancer 60(6):1331–1336
Rossi A, Ganassini A, Tantucci C et al (1996) Aging and the respiratory system. Aging (Milano) 8(3):143–161
Janssens JP, Pache JC, Nicod LP (1999) Physiological changes in respiratory function associated with aging. Eur Respir J 13:197–205
Meyer KC (2004) Lung infections and aging. Ageing Res Rev 3(1):55–67
Verra F, Escudier E, Lebargy F et al (1995) Ciliary abnormalities in bronchial epithelium of smokers, ex-smokers, and nonsmokers. Am J Respir Crit Care Med 151(3):630–634
Salathe M, O’Riordan TG, Wanner A (1996) Treatment of mucociliary dysfunction. Chest 110:1048–1057
McLesky CH (1992) Anesthesia for the geriatric patient. In: Barash PG, Cullen BF, Staelting RK (eds) Clinical anesthesia, 2nd edn. JB Lippincott, Philadelphia, pp 1353–1383
Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. Circulation 130:e278–e333
Passman RS, Gingold DS, Amar D et al (2005) Prediction rule for atrial fibrillation after major noncardiac thoracic surgery. Ann Thorac Surg 79:1698–1703
Roselli EE, Murthy SC, Rice TW et al (2005) Atrial fibrillation complicating lung cancer resection. J Thorac Cardiovasc Surg 130:438–444
Sedrakyan A, Treasure T, Browne J et al (2005) Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: evidence from randomized clinical trials. J Thorac Cardiovasc Surg 129:997–1005
British Thoracic Society, Society of Cardiothoracic Surgeons of Great Britain and Ireland Working Party (2001) Guidelines on the selection of patients with lung cancer for surgery. Thorax 56:89–108
Colice GL, Shafazand S, Griffin JP et al (2007) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidence-based clinical practice guidelines (2nd ed). Chest 132:161–177
Wyser C, Stulz P, Soler M et al (1999) Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Am J Respir Crit Care Med 159:1450–1456
Datta D, Lahiri B (2003) Preoperative evaluation of patients undergoing lung resection surgery. Chest 123:2096–2103
Linden PA, Bueno R, Colson YL et al (2005) Lung resection in patients with preoperative FEV1 < 35% predicted. Chest 127:1984–1990
Ferguson MK, Little L, Rizzo L et al (1988) Diffusing capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg 96:894–900
Stephan F, Boucheseiche S, Hollande J et al (2000) Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 118:1263–1270
Botsen PC, Block AJ, Moulder PC (1981) Relationship between preoperative pulmonary function tests and complications after thoracotomy. Surg Gynecol Obstet 52:813–815
Girish M, Trayner E, Dammann O et al (2001) Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high risk surgery. Chest 120:1147–1151
Solway S, Brooks D, Lacasses Y et al (2001) A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest 119(1):256–270
Jaklitsch MT, Mery CM, Audisio RA (2003) The use of surgery to treat lung cancer in elderly patients. Lancet Oncol 4:463–471
Olsen GN, Block AJ, Tobias JA (1974) Prediction of postpneumonectomy pulmonary function using quantitative macroaggregate lung scanning. Chest 66:13–16
Pate P, Tenholder MF, Griffin JP et al (1996) Preoperative assessment of the high-risk patient for lung resection. Ann Thorac Surg 61:1494–1500
Markos J, Mullan BP, Hillman DR et al (1989) Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 139:902–910
Bolliger CT, Wyser C, Boser H et al (1995) Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk of complications. Chest 108:947–348
Holden DA, Rice TW, Stefmach K et al (1992) Exercise testing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection. Chest 102:1774–1779
Wahi R, McMurtry MJ, DeCaro LF et al (1989) Determinants of perioperative morbidity and mortality after pneumonectomy. Ann Thorac Surg 48:33–37
Brock MV, Kim MP, Hooker CM et al (2004) Pulmonary resection in octogenarians with stage I nonsmall cell lung cancer: a 22-year experience. Ann Thorac Surg 77:271–277
Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet 351:857–861
Hshieh TT, Saczynski J, Gou RY et al (2017) Trajectory of functional recovery after postoperative delirium in elective surgery. Ann Surg 265:647–653
Rasmussen LS, Siersma VD, ISPOCD Group (2004) Postoperative cognitive dysfunction: true deterioration versus random variation. Acta Anesthesiol Scand 48:1137–1143
Newman S, Stygall J, Shaefi S et al (2007) Postoperative cognitive dysfunction after noncardiac surgery. Anesthesiology 106:572–590
Kaneko T, Takahashi S, Naka T et al (1997) Postoperative delirium following gastrointestinal surgery in elderly patients. Surg Today 27:107–111
Fukuse T, Satoda N, Hijiya K et al (2005) Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest 127:886–891
Narian O, Rubenstein L et al (1988) Predictors of immediate and 6 month outcomes in hospitalized elderly patients. The importance of functional status. J Am Geriatr Soc 36:775–783
Reuben D, Rubenstein L et al (1992) Value of functional status as a predictor of mortality: results of a prospective study. Am J Med 93(6):663–669
Landi F, Giuseppe G et al (1999) Body mass index and mortality among older people living in the community. J Am Geriatr Soc 47:1072
Audisio RA, Ramesh H, Longo W et al (2005) Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 10:262–268
Rubenstein LZ, Schairer C, Wieland GD, Kane R (1984) Systematic biases in functional status assessment of elderly adults: effects of different data sources. J Gerontol 39(6):686–691
Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32A(7):1135
Harpole DH Jr, Herndon JF 2nd, Young WG Jr et al (1995) Stage I nonsmall cell lung cancer: a multivariate analysis of treatment methods and patterns of recurrence. Cancer 76:787–796
Stamatis G, Djuric D, Eberhardt W et al (2002) Postoperative morbidity and mortality after induction chemoradiotherapy for locally advancer lung cancer: an analysis of 350 operated patients. Eur J Cardiothorac Surg 22:292–297
Ferguson MK, Vigneswaran WT (2008) Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease. Ann Thorac Surg 85(4):1158–1164
O’Rourke MA, Feussner JR, Feigl P et al (1987) Age trends of lung cancer stage at diagnosis: implications for lung cancer screening in the elderly. JAMA 258:921–926
Mery CM, Pappas AN, Bueno R et al (2005) 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 128:237–245
Weinmann M, Jeremie B, Toomes H et al (2003) Treatment of lung cancer in the elderly. Part I. Non-small cell lung cancer. Lung Cancer 39:233–253
Morandi U, Stefani A, Golinelli M et al (1997) Results of surgical resection in patients over the age of 70 years with non small-cell lung cancer. Eur J Cardiothorac Surg 11:432–439
Gail MH, Eagan RT, Feld R et al (1984) Prognostic factors in patients with resected state I non-small cell lung cancer: a report from the Lung Cancer Study Group. Cancer 54:1802–1813
Mountain CF, Lukeman JM, Hammar SP et al (1987) Lung cancer classification: the relationship of disease extent and cell type to survival in a clinical trials population. J Surg Oncol 35:147–156
Deslauriers J, Gregoire J (2000) Surgical therapy of early non-small cell lung cancer. Chest 117(suppl):104S–109S
Faulkner SL (2000) Is Lobectomy the “gold standard” for stage I lung cancer in year 2000? Chest 118(suppl):119S
Bates M (1970) Results of surgery for bronchial carcinoma in patients aged 70 and over. Thorax 25:77–78
Evans EW (1973) Resection of bronchial carcinoma in the elderly. Thorax 28:86–88
Kirsh MM, Rotman H, Bove E et al (1976) Major pulmonary resection for bronchial carcinoma in the elderly. Ann Thorac Surg 22:369–373
Harviel JD, McNamara JJ, Straehley CJ (1978) Surgical treatment of lung cancer in patients over the age of 70 years. J Thorac Cardiovasc Surg 75:802–805
Ginsberg RJ, Hill LD, Eagan RT et al (1983) Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg 86:654–658
Mery CM, Jaklitch MT (2006) Lung resection in the elderly, correspondence. Chest 129:496–497
Albano WA (1977) Should elderly patients undergo surgery for cancer. Geriatrics 32:105–108
Breyer RH, Zippe C, Pharr WF et al (1981) Thoracotomy in patients over age seventy years: ten-year experience. J Thorac Cardiovasc Surg 81:187–193
Zapatero J, Madrigal L, Lago J et al (1990) Thoracic surgery in the elderly: review of 100 cases. Acta Chir Hung 31:227–234
Allen MS, Darling GE, Pechet TT, ACOSOG Z0030 Study Group et al (2006) Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81(3):1013–1019
Decamp MM Jr, Jaklitsch MT, Mentzer SJ et al (1995) The safety and versatility of video-thoracoscopy: a prospective analysis of 895 cases. J Am Coll Surg 181:113–120
McKenna R (1994) Thoracoscopic lobectomy with mediastinal sampling in 80 year-old patients. Chest 106:1902–1904
Landreneau RL, Sugarbaker DJ, Mack MJ et al (1993) Postoperative pain-realted morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 56:1285–1289
Jaklitsch MT, Bueno R, Swanson SJ et al (1996) Video-assisted thoracic surgery in the elderly: a review of 307 cases. Chest 110:751–758
Cattaneo SM, Park BJ, Wilton AS et al (2008) Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg 85:231–236
Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60(3):615–622; discussion 622–623
Landreneau RJ, Sugarbaker DJ, Mack MJ et al (1997) Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer. J Thorac Cardiovasc Surg 113(4):691–700
Kulke MH, Mayer RJ (1999) Carcinoid tumors. N Engl J Med 340(11):858–868
Marty-Ane C, Costes V, Pujol J et al (1995) Carcinoid tumors of the lung: do atypical features require aggressive management? Ann Thorac Surg 59(1):78–83
Mezzetti M, Raveglia F, Panigalli T et al (2003) Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification. Ann Thorac Surg 76(6):1838–1842
Jaklitsch MT, Mery CM, Lukanich JM et al (2001) Sequential thoracic metastasectomy prolongs survival by re-establishing local control within the chest. J Thorac Cardiovasc Surg 121(4):657–667
Inoue M, Ohta M, Iuchi K et al (2004) Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg 78(1):238–244
Weiser MR, Downey RJ, Leung DH, Brennan MF (2000) Repeat resection of pulmonary metastases in patients with soft-tissue sarcoma. J Am Coll Surg 191(2):184–190; discussion 190–191
Saito Y, Omiya H, Kohno K et al (2002) Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg 124(5):1007–1013
Pfannschmidt J (2003) Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. J Thorac Cardiovasc Surg 126(3):732–739
Carballo M, Maish M, Jaroszewski D, Holmes C (2009) Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 4(1):13
The International Registry of Lung Metastases, Writing Committee, Pastorino U et al (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113(1):37–49
Collie DA, Wright AR, Williams JR et al (1994) Comparison of spiral-acquisition computed tomography and conventional computed tomography in the assessment of pulmonary metastatic disease. Br J Radiol 67(797):436–444
McCormack PM, Bains MS, Begg CB et al (1996) Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial. Ann Thorac Surg 62(1):213–216
Reinhardt M, Wiethoelter N, Matthies A et al (2006) PET recognition of pulmonary metastases on PET/CT imaging: impact of attenuation-corrected and non-attenuation-corrected PET images. Eur J Nucl Med Mol Imaging 33(2):134–139
Nakajima J, Takamoto S, Tanaka M et al (2001) Thoracoscopic surgery and conventional open thoracotomy in metastatic lung cancer. Surg Endosc 15(8):849–853
Mutsaerts E, Zoetmulder F, Meijer S et al (2002) Long term survival of thoracoscopic metastasectomy vs metastasectomy by thoracotomy in patients with a solitary pulmonary lesion. Eur J Surg Oncol 28(8):864–868
Samet J, Hunt WC, Key C et al (1986) Choice of cancer therapy varies with age of patient. JAMA 255:3385–3390
Gridelli C, Langer C, Maione P et al (2007) Lung cancer in the elderly. J Clin Oncol 25(14):1989–1907
McGarry RC, Song G, des Rosiers P et al (2002) Observation-only management of early stage, medically inoperable lung cancer: poor outcome. Chest 121:1155–1158
Yellin A, Brenfield JR (1985) Surgery for bronchogenic carcinoma in the elderly. Am Rev Respir Dis 131:197
Arias E (2007) CDC. Natl Vital Stat Rep 56(9)
Goldstraw P et al (2016) The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 11(1):39–51
National Center for Health Statistics (2017) Health, United States, 2016: with chartbook on long-term trends in health. National Center for Health Statistics, Hyattsville
Author information
Authors and Affiliations
Corresponding authors
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Fox, S., Bravo-Iñiguez, C., De Leon, L., Tarascio, J., Jaklitsch, M. (2020). Pulmonary Surgery for Malignant Disease in Older Adults. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47771-8_40
Download citation
DOI: https://doi.org/10.1007/978-3-319-47771-8_40
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-47770-1
Online ISBN: 978-3-319-47771-8
eBook Packages: MedicineReference Module Medicine