Thoracic Surgery in the Elderly

Abstract

As the population ages, increasing numbers of elderly patients are presenting for thoracic surgery. Physiologic changes that occur with advanced age result in a decline of maximal reserves, affecting the patient’s ability to cope with the stress of surgery. Increased age is also associated with an increase in the number of comorbidities. Elderly patients with cancer may still stand to benefit from surgery, since survival rates for lung and esophageal cancer are very low without surgical resection. Perioperative morbidity and mortality is more closely associated with preoperative health status and tumor stage than chronological age. Minimally invasive surgical techniques such as video-assisted thoracoscopic surgery (VATS) have been shown to be an effective approach for surgical resection of cancer. Because better postoperative pulmonary function, less postoperative pain, and fewer complications were shown for patients who underwent VATS compared to those who underwent thoracotomy for lobectomy, VATS may be a good choice for patients of advanced age due to their decreased physiologic reserves. Careful preoperative assessment and postoperative care are essential in this surgical population due to their diminished ability to handle the stress of surgery.