The following is a summary of “Peri- and postoperative morbidity and mortality in older patients with non-small cell lung cancer: a matched-pair study,” published in the August 2024 issue of Surgery by Safi et al.

This study aimed to evaluate the differences in morbidity and mortality following surgery with curative intent for non-small cell lung cancer (NSCLC) between older patients (aged ≥75 years) and younger patients (aged <75 years) while also identifying independent risk factors that influence outcomes. Although prior case series have suggested that operative outcomes are similar across different age groups, a more detailed analysis was necessary to understand the potential impact of age on surgical success and long-term survival.

The study retrospectively analyzed 2,015 patients with postoperative stages IA to IIIA NSCLC, according to the AJCC/UICC 7th edition, who underwent surgery at a specialized lung cancer center between January 2010 and December 2015. A matched-pair analysis was performed, comparing 227 older patients with an equal number of younger patients, ensuring that both groups were comparable regarding key clinical variables. The primary outcomes assessed included short-term postoperative morbidity, length of hospital stay, 30-day and 90-day mortality, and long-term outcomes such as disease-free and overall survival.

In the matched-pair cohort of 454 patients, 36% of younger patients experienced postoperative complications, compared to 42% of older patients, a difference that was not statistically significant (p = 0.163). The median hospital stay was similar between the two groups, with older patients staying 14 days and younger patients staying 13 days (p = 0.185). Mortality within 90 days post-surgery was 4% in older patients compared to 2.2% in younger patients, although this difference was also not statistically significant (p = 0.424).

In the older cohort, several factors were identified as significantly associated with decreased overall survival, including impaired performance status (ECOG ≥1) with a hazard ratio (HR) of 2.15 (95% CI 1.34–3.46), a preoperative serum C-reactive protein/albumin ratio ≥0.3 (HR 1.95, 95% CI 1.23–3.11), and elevated preoperative serum creatinine levels ≥1.1 mg/dl (HR 1.84, 95% CI 1.15–2.95). Conversely, in the younger cohort, male sex (HR 2.26, 95% CI 1.17–4.36), postoperative stage III disease (HR 4.61, 95% CI 2.23–9.54), and preoperative anemia (hemoglobin <12 g/dl) (HR 2.09, 95% CI 1.10–3.96) were linked to poorer survival outcomes.

In conclusion, the results indicate that lung resection for NSCLC in older patients carries postoperative morbidity and mortality rates comparable to those in younger patients. Therefore, physical fitness, comorbidities, and nutritional status should be prioritized over age when considering surgical interventions for older patients. These findings underscore the importance of a comprehensive preoperative assessment to optimize surgical outcomes across all age groups.

Source: wjso.biomedcentral.com/articles/10.1186/s12957-024-03491-6