Surgical Outcomes Of Non-small Cell Lung Cancer In Octogenarians With Increased Severity In Comorbidities
Alexander Leung, Harmik J. Soukiasian, Taryne A. Imai.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
BACKGROUND: With life expectancy increasing, the surgical management of T1a Non-Small Cell Lung Cancer(NSCLC) in healthy octogenarians has been explored more, with many demonstrating acceptable outcomes and survival. Currently, there are no studies investigating outcomes of octogenarians with increased severity in comorbidities. We compare the perioperative outcomes and survival of octogenarians with increased comorbidities and larger-sized NSCLC by resection type and surgical approach.
METHODS: The National Cancer Database(2004-2018) was queried for patients ≥80 years-old with Charlson-Deyo Scores(CDS)≥3 and pathologic tumor size 2-5cm(T1c, T2a, T2b) who underwent wedge, segmentectomy or lobectomy. Patients were stratified into 2 groups based on tumor size(2-3cm and >3-5cm). Perioperative outcomes were compared by resection type utilizing ANOVA analysis. Perioperative outcomes of lobectomy patients were then compared by surgical approach (minimally invasive[MIS] vs. open). Mean overall survival was compared by the Kaplan-Meier method and log-rank test. Subgroup analysis of patients without nodal disease(N0) compared survival by resection type in both groups.
RESULTS: 688 patients met inclusion criteria. Both groups were similar in R0 resection, 30-day readmission, 30-day and 90-day mortality amongst resection type(Figure 1A). Length of stay(LOS) was similar for the 2-3cm group and longer for lobectomy in the >3-5cm group(p<0.01). Comparing surgical approach amongst lobectomy patients with 2-3cm tumors demonstrated shorter LOS in the MIS approach(p=0.04)(Figure 1B). MIS lobectomy with >3-5cm tumors demonstrated decreased LOS, 30-day readmission, 30-day and 90-day mortality compared to open(Figure 1B). Patients with 2-3 cm tumors demonstrated worse mean overall survival with wedge(29.6mo) vs. lobectomy(36.5mo) vs. segmentectomy(37.1mo)(p=0 .01). In the >3-5cm group, wedge(27.9mo) also demonstrated worse survival compared to lobectomy(30.9mo) and segmentectomy(33.1mo)(p=0.01)(Figure 1C). Subgroup analysis of the 2-3cm group with N0 disease, demonstrated no difference in overall survival(wedge[46.8mo] vs. segmentectomy[50.1mo] vs. lobectomy[55.2mo]; p=0.32). Whereas, the >3-5cm group with N0 disease who underwent lobectomy(51.2mo) and segmentectomy(55.4mo) had improved overall survival compared to wedge(39.6mo)(p=0.02).
CONCLUSIONS: Octogenarians with high comorbidities can undergo anatomic segmentectomy and lobectomy with comparable perioperative risk and superior mean overall survival compared to wedge resection. Patients with larger(>3-5cm) tumors undergoing MIS lobectomy have improved perioperative outcomes and those with N0 disease undergoing anatomic resection have superior survival compared to wedge. 
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