Surgical Invasiveness Trumps Chronological Age: Determinants of Short-Term Recovery in Octogenarian Lung Cancer Patients.

OBJECTIVE

To characterize perioperative outcomes and quantify the relative contribution of patient-related versus procedure-related factors to short-term recovery (LOS and CTD) in octogenarians undergoing minimally invasive lung resection within an ERAS pathway.

METHODS

We reviewed 106 consecutive patients aged 80 years or older with suspected primary NSCLC who underwent video-assisted or robotic-assisted resection (2020-2025) under standardized ERAS care. Primary outcomes were LOS and CTD. Determinants were assessed with multivariable linear models of log(LOS + 1) and log(CTD + 1) among malignant survivors (n = 99).

RESULTS

Median age was 81 years (IQR 80-83); 57.5% were men. Procedures included wedge resection (52.8%), segmentectomy (9.4%), and lobectomy (37.7%); 96.2% were VATS and 3.8% RATS. Median LOS was 4.0 days (IQR 3.0-5.8) and CTD 3.0 days (IQR 1.0-4.0). Complications occurred in 13.2%, and perioperative mortality was 0.9%. Sublobar resection (vs. lobectomy) was independently associated with shorter LOS (standardized beta -0.262, p = 0.011) and CTD (standardized beta -0.326, p = 0.001). Age was not associated with LOS, but showed a small inverse association with CTD (standardized beta -0.219, p = 0.018). No patient was readmitted within 30 days, chest tube reinsertion occurred in 1 patient (0.9%), and 10 patients (9.4%) were transferred to lower-level hospitals after discharge.

CONCLUSIONS

In carefully selected octogenarians managed with minimally invasive surgery and ERAS, surgical invasiveness (extent of resection) was the dominant modifiable driver of recovery, whereas chronological age alone provided limited incremental discrimination of recovery speed. Favorable in-hospital recovery was not associated with increased short-term adverse events after discharge.