Prevalence of and risk factors for pulmonary complications after lung cancer surgery in elderly patients with preserved lung function

Background: The prevalence of lung cancer in elderly patients is increasing. Few studies are available regarding the risk factors for postoperative pulmonary complications (PPCs) to select the optimal candidates for surgical resection in elderly patients with non-small cell lung cancer (NSCLC). Methods: A total of 488 patients, who were older than 70 years with normal spirometry result and underwent curative resection for NSCLC from January 2012 to December 2016 were included. Primary outcome was PPCs in 60 days postoperatively and associated clinico-radiologic factors, and secondary outcome was all-cause mortality. Results: Overall, 52 patients (10.2%) had PPCs. Compared to patients without PPCs, those who had PPCs were more likely to be male (p=0.003) and current-smokers (p=0.013), have lower body mass index (p=0.007), higher American Society of Anesthesiologist classification (p=0.021), more interstitial lung abnormalities (ILA) (p=0.004) and higher emphysema index (p=0.006) on computed tomography scan, and have undergone pneumonectomy or bilobectomy (p=0.005). In multivariable analysis, ILA and extent of resection were independently associated with risk of PPCs. All-cause mortality was significantly higher in those with PPC, in both short-term and long-term periods. Conclusion: Pulmonary resection for early-stage NSCLC in elderly patients with preserved lung function appeared feasible with 10% of PPCs. Presence of ILA in CT scan and larger extent of resection is two important predictors of PPCs development, guiding treatment decision-making in these patients.