Good news in lung surgery

Technological advances have made surgery a better option for older patients with multiple co-morbidities, especially with lung cancer.

“In the past 10 years, surgery has seen advances in minimally-invasive techniques, smaller incisions and robotics, so we’ve been able offer the elderly population a much more tolerable approach to lung-cancer resection,” D’Cunha said. With traditional open procedures, recovery from large lung resections could be quite debilitating.

“Now we’re able to offer patients who may have not thought of being resected a shorter LOS and greater recovery,” he explained.

D’Cunha cautioned that, while surgery should be a consideration in older patients, it still can have significant downsides; for example, complications can make long-term prognosis even worse than the disease being treated.

“Just because they’re older, that does not mean they are all the same,” he said. “If you can understand all the variables, you can have better predictive ability. He considers larger tumors and co-morbidities such as cardiac or renal disease risk factors that might argue against surgery.

It is even more essential for elderly patients to be treated at a specialized facility, such as a VA Center for Excellence. A more experienced care team, “will be more focused on specific pathways to avoid these post-op issues,” according to D’Cunha.

He noted that the Minnesota VAMC has thoracic surgeons specifically trained to treat lung cancer, while that is not the case at all VA facilities.

“If you use recommended pathways and can recognize complications and intervene in a forward way the patient will be much better off,” he said.

Back to 2012 Compendium

1. Al-Refaie WB, Parsons HM, Habermann EB, Kwaan M, Spencer MP, et al. Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old. Ann Surg. 2011 May;253(5):947-52.

2. Al-Refaie WB, Parsons HM, Henderson WG, Jensen EH, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program.
Ann Surg. 2010 Feb;251(2):311-8.