Octogenarians are rarely referred for thoracic operations, presumably owing to the perceived morbidity of
thoracotomy and the presumed
frailty and limited life span of the 80-year-old patient. To determine if these concerns are valid, we reviewed our operative experience in 50 patients 80 years of age or older (mean age, 82.7 years; range, 80 to 91 years; 29 men, 21 women) undergoing
thoracotomy between Nov 1, 1980, and May 1, 1990, for
cancer (39 patients) and benign disease (11 patients). Procedures included 25 lobectomies (24
cancer, 1
abscess), 4
pneumonectomies (all
cancer), 3
esophagectomies (1 perforation, 2
cancer), 3 explorations for
cancer, 2 bullectomies, 12 wedge or segmental resections (5 open lung biopsies, 5
cancer, and 1 each for benign nodule and
hemoptysis), and 1
thymectomy. Five patients (10%) were operated on emergently for massive
hemoptysis (1),
Boerhaave's syndrome (1), or rapidly progressive
respiratory insufficiency (3) with an operative mortality of 80%. Mortality for elective cases was significantly lower (13%, p less than 0.01). Major complications occurred in 19 patients (38%). Univariate analysis performed to identify predictors of operative mortality demonstrated no significant relationship between operative death and patient age, sex, type of operation, diagnosis of
malignancy, or the presence of either
cardiac disease or
chronic obstructive lung disease. Twenty-three patients are alive 2 months to 5 years after
thoracotomy. Actuarial survival for the 45 elective patients was 56% and 44% at 1 and 2 years, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)