Outcomes of Video-Assisted Thoracoscopic Lobectomy in Octogenarians Following Enhanced Recovery After Surgery Protocols.

OBJECTIVES

The improvements from minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols have enabled more octogenarians to be considered for curative treatment of early-stage lung cancer. However, evidence on short-term outcomes after ERAS-guided Video-Assisted Thoracoscopic Surgery (VATS) lobectomy in this age group remains limited. The aim was to evaluate perioperative outcomes and assess specific challenges in octogenarians undergoing VATS lobectomy following a well-established ERAS-protocol.

METHODS

We conducted a retrospective observational study of consecutive adults undergoing VATS lobectomy within an ERAS program from 2009 to 2024. All patients followed standardized care and followed an ERAS protocol. Patients aged ≥80 years underwent an additional preoperative risk assessment.

RESULTS

Among 4,602 patients, 335 (7.3%) were octogenarians (median age 82 years, IQR 81-83). Median length of stay was one day longer among octogenarians (4 (IQR: 2-7) vs 3 days (IQR: 2-6), p = 0.004). Overall complication rates were comparable between octogenarians and younger patients, except for postoperative atrial fibrillation (octogenarians 12% vs 7.6%, p = 0.012). Within 30 days, 40 octogenarians (11.9%) were readmitted, most commonly for pneumonia (30%), pneumothorax (25%), and pleural effusion (20%). 30-day mortality was not statistically different between octogenarians and younger patients (octogenarians 1.8% vs 1.2%, p = 0.29). The number of octogenarians undergoing VATS lobectomy has increased from 2.5% of all patients in 2009 to 11.7% in 2024.

CONCLUSION

VATS lobectomy within an ERAS framework appears safe and feasible in carefully selected octogenarians, yielding acceptable short-term outcomes. Chronological age alone should not preclude surgical treatment.