# Surgical Outcomes of Minimally Invasive Lung Resection in Nonagenarians: A Retrospective Analysis of Seven Patients at a Single Institution

## TL;DR

This study shows that minimally invasive lung surgery can be safe and effective for nonagenarians with lung cancer when carefully evaluated.

## Contribution

The paper introduces a holistic assessment approach using radar plots to evaluate nonagenarians for lung surgery.

## Key findings

- All seven nonagenarians had stable postoperative outcomes with minimal complications.
- Median overall survival was 4.1 years, with most patients showing favorable long-term survival.
- A holistic assessment approach was developed to guide personalized care for elderly patients.

## Abstract

Introduction

With the global trend of aging populations, the number of nonagenarians diagnosed with malignancies, including lung cancer, is increasing. Despite advancements in minimally invasive surgical techniques, lung resection for nonagenarians remains rare due to concerns regarding comorbidities and surgical risks. This study evaluates the surgical outcomes of lung resection in nonagenarians and introduces a holistic assessment approach to optimize patient care.

Methods

A retrospective review of surgical records from January 2011 to December 2022 identified seven nonagenarians who underwent lung resection under 3-port video-assisted thoracoscopic surgery (VATS). Patient characteristics, surgical details, and postoperative outcomes were analyzed. To holistically evaluate each patient, multifaceted surgical tolerance and prognostic factors were summarized and visualized in a radar plot.

Results

The study cohort consisted of four males and three females aged 90 to 96 years. Wedge resection was performed in six patients, and one patient underwent lobectomy. Mediastinal lymph node dissection was not performed. The median duration of chest tube insertion was two days, and 86% of patients were discharged within one week. Postoperative complications were minimal, with one case of delirium and no occurrences of pneumonia. All patients were discharged in stable condition without deterioration of their activities of daily living. The median overall survival was 4.1 years. One patient succumbed to lung cancer progression, while the remaining patients exhibited favorable long-term survival without recurrence, including one patient whose lung tumor was a metastasis from colorectal cancer. As depicted in the radar plots, all patients had at least one risk factor other than their age.

Conclusion

Lung resection under a minimally invasive approach is feasible for carefully selected nonagenarians, yielding favorable short- and long-term outcomes. Because super-elderlies likely harbor multiple comorbidities, a holistic assessment of each patient is important for personalized patient care.