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Comparison of surgical outcome of lung cancer between video-assisted thoracic surgery (VATS) and open thoracotomy in patients aged 80 or over.
Taichiro Ishizumi1, Yasufumi Kato2, Tatsuya Inoue1, Norihiko Ikeda2, Jitsuo Usuda1.
1Nippon medical school, Tokyo, Japan, 2Tokyo medical University, Tokyo, Japan.

OBJECTIVE: The effectiveness of VATS for elderly patients with lung cancer is unclear. We compared the postoperative course of VATS and thoracotomy in patients aged 80 or over who underwent lobectomy for lung cancer.
METHODS: We retrospectively reviewed the charts of 72 patients aged 80 or over who underwent lobectomy and systematic lymph node dissection for previously untreated lung cancer between January 2007 and October 2012.
RESULTS: The mean age was 81.6 (range 80-88). The pathological stages were IA in 25, IB in 33, IIA in 6, IIB in 3, and III A in 5 cases. We performed thoracotomy in 52 patients and attempted VATS lobectomy in 20 patients, but 1 case converted to thoracotomy due to pulmonary artery injury. The median operative duration was 207 minutes for the thoracotomy group and 213 minutes for the VATS group (p=0.821). The median blood loss was 82.0 ml for thoracotomy group and 74.5 ml for VATS group (p=0.544). The median chest tube indwelling duration was 3.8 days for the thoracotomy group and 4.2 days for the VATS group (p=0.271). The median hospital stay was 10.5 days for the thoracotomy group and 10.2 days for the VATS group (p=0.496). Postoperative complications occurred in 14 patients (19.4%); prolonged air leak in 7, pneumonia in 5, atrial arrhythmias in 3, delirium in 3, and bronchopleural fistula in 1. There were no significant differences in the occurrence of complications between the two groups. However, these groups had a significantly higher incidence of complications than patients aged under 80.
CONCLUSIONS: VATS lobectomy for elderly patients can be performed relatively safely without severe complications. However, as shorter hospitalization associated with minimally invasive procedure was unattainable due to mild complications, pre-and post-operative management in elderly patient requires considerable attention.


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