Pulmonary Surgery for Malignant Disease in the Elderly

Lung cancer is a disease of the elderly. Early stage disease is best cured by surgery, and with the aging of the US population, the elderly are more frequently being evaluated for resection of pulmonary malignancies. Elderly cancer patients should undergo a complete staging workup unless their degree of functional status impairment precludes treatment. A thorough preoperative workup can delineate patients who are at high risk for perioperative morbidity and mortality. The decision to proceed with resection should be based on the stage of disease, pulmonary function, functional status, and the patient’s goals, rather than the age alone. Lung resections in the aged must balance the need for complete oncologic resection with the ability of the elderly to recover from insult. The use of thoracoscopic techniques should be used whenever possible to avoid the risk associated with thoracotomy. The paradigm for surgical management of elderly patients will continue to coevolve with advances in technology.