The Value Of Thoracoscopic-Assisted Pulmonary Lobectomy And Mediastinum Lymph Node Dissextion In Elderly Patients With Non-small Lung Cancer

Objective: Surgery is one of the most important treatments of non-small cell lung cancer(NSCLC). Traditionaly, elderly patients are not suitable for thoracotomy,because of poor cardiopulmonary function, more complications and high mortality rate.Video-assisted thoracoscopic surgery (VATS) has many advantages, such as less trauma, more safety, faster recovery and less complications. Currently, VATS lobectomy and mediastinal lymph node dissection is a main surgical strategy for the treatment of NSCLC^1-3. However, it hasn't unified about whether VATS lobectomy and mediastinal lymph node dissection are feasible for the elderly patients. The aim of our study is to study the value of VATS lobectomy and mediastinal lymph node dissection in the treatment of elderly patients with NSCLC by assessing surgical trauma, postoperative recovery, postoperative complications and prognosis.Materials and Methods: Retrospectively analyzed the clinical pathological records of 225 patients with NSCLC who received VATS lobectomy and mediastinal lymph node dissection in our Union Hospital from July 2007 to November 2010. Divided patients into two groups, the elderly group (≥70 years old) and the non-elderly group (<70 years old). There were 43 cases and 182 cases,respectively. And 38 cases enrolled in the elderly group, 57 cases which were randomly selected enrolled in non-elderly group.Compared the surgical trauma, postoperative recovery, postoperative complications and prognosis between the two groups.Results: The differences about background diseases,pulmonary function between the two groups were statistically significant (P=0.004,0.000,0.010).There was no significant difference in duration of surgery, volume of peri-operative bleeding, volume of blood transfusion, total post-operative drainage, length of hospital stay,and the use of painkiller (P>0.05). The incidence of cardiovascular complications in the elderly group was higher(23.7% vs. 1.8%, P=0.001).The metastasis lymph node rate of the elderly group was lower, with no statistical difference(4.2% vs. 8.6%, P=0.144),so were N1 and N2 lymph node rates (3.4% vs. 84%,4.7% vs.8.0%,P=0.050,0.358).The 1-year and 2-year survival rate was 96.4%,97.8% and 73.1%,78.1%,respectively(P=0.161).Conclusions: With increasing age, background diseases of the elderly patients increase, and cardiopulmonary function declines. However, old age should not be the surgical contraindication. Based on the cardiopulmonary function evaluation,the elderly patients could tolerate VATS lobectomy and mediastinal lymph node dissection, which is the same as ones aged less than 70. There was no difference about early prognosis between the elderly and the non-elderly patients.Overall, VATS lobectomy and mediastinal lymph node dissection was a safe and feasible surgical strategy for the treatment of elderly patients with NSCLC.