478P - Peri-operative risks in curative lung resection of early stage primary lung cancer patients above 70 years old in a mixed Asian population

Background

Lung cancer is commonly diagnosed after 40 years old and surgical lung resection is the recommended treatment for early stage lung cancer. The mean age of presentation is around 70 years old but there remained concerns on performing surgery in these patients. These concerns were addressed with advances in surgical technique and we aimed to review our experience of performing curative lung resection in patients above 70 years old.

Methods

We performed a retrospective review of all patients who underwent curative surgery for primary lung cancers between 2018 and 2021 and compared the outcome between patients 70 years old and above against those who were younger.

Results

289 were reviewed, of which 180 patients (62.3%) were under 70 years old and 109 patients (37.7%) were 70 years old and above. Patients above 70 years had a significantly higher incidence of hypertension, hyperlipidemia, diabetes mellitus, ischaemic heart disease and renal impairment but there was no significant difference in the incidence of previous stroke, atrial fibrillation, congestive heart failure and chronic obstructive pulmonary disease. There was also no significant difference between the pre-operative FEV1 and DLCO between the 2 groups of patients. Patients above 70 years old were at higher risk of developing pneumonia (OR 2.28, 95% CI 1.65-3.13, p = 0.003), respiratory failure (OR 2.71, 95% CI 2.33-3.16, p = 0.020) and unplanned return to the ICU (OR 2.41, 95% CI 1.78-3.27, p = 0.005). Peri-operative mortality was also higher in patients above 70 years old but this was statistically not significant. (OR 1.94, CI 1.18-3.17, p = 0.073). There was no significant difference in the post-operative incidence of cardiac, renal or wound complications. No patients developed a peri-operative stroke.

Conclusions

Our study demonstrated that patients above 70 years old may be more susceptible to pulmonary complications such as pneumonia and respiratory failure that may in turn lead to higher peri-operative mortality. Care can be taken to mitigate these complications such as pre-operative pulmonary rehabilitation and early mobilisation but this should not preclude patients above 70 years old from undergoing curative lung resection surgery.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.