Pneumonectomy vs. Sleeve Resection for Non-Small Cell Lung Carcinoma in the Elderly: Analysis of Short-term and Long-term Results

Background: Aim of the study was to assess the short-and long-term results of sleeve resections and pneumonectomies for centrally located non-small cell lung cancer (NSCLC) in a cohort of elderly patients. Methods: We retrospectively reviewed our prospective database of all patients aged >= 70 years who underwent sleeve resection (SL group) or pneumonectomy (PN group) for NSCLC between January 1999 and December 2005. Patients' characteristics, morbidity, mortality and survival were analyzed and compared between groups. Results: Sixty patients qualified for the analysis, of whom 31 underwent sleeve resection and 29 had pneumonectomy. Both groups were statistically equivalent with regard to age (73.6 +/- 2.4 vs. 74.2 +/- 3.6 years), sex, comorbidities, histology, completeness of resection and stage. Presurgical FEV1 was higher in the PN group (p = 0.02). There were no statistical differences in the morbidity rate (SL: 41.9%, PN: 44.8%), mortality rate (SL: 6.5%, PN: 10.3%), local recurrence (SL: 3.2%, PN: 0%) or distant metastases (SL: 19.4%, PN: 24.1%). The loss of FEV1 was higher in the PN group (27.3%) compared to the SL group (12.0%; p = 0.001). Overall 5-year survival and mean survival for SL patients was 59% and 51.9 months compared to 0% and 30.1 months for the PN patients (p = 0.038). In patients with stage N2 disease, the type of surgery showed a trend to prolonged long-term survival favoring sleeve resection (p = 0.096). Conclusion: In specialized centers both pneumonectomy and sleeve resection can be performed with acceptable mortality and morbidity rates in elderly patients with centrally located NSCLC. In elderly patients with anatomically suitable NSCLC, sleeve resections offer better functional results and long-term survival irrespective of nodal status.