Surgery: Indications and issues

Surgery in elderly patients affected by NSCLC is safe and feasible when careful preoperative respiratory and cardiac studies have been carried on. The ­surgical treatment is not to be denied in an elderly patient due to age per se, but when a major contraindication to surgery has been recognized. The long-term ­survival for elderly patients with early-stage lung cancer treated by anatomical ­pulmonary resection is comparable to the survival rate of younger patients, as ­demonstrated by several studies. Nowadays studies in elderly patients have ­demonstrated that pneumonectomy, extended surgical procedure, and preoperative induction chemotherapy are major risk factors for an increased postoperative ­morbidity and mortality rate. Anyway, in our opinion, the proper selected elderly patient with NSCLC should be treated in the same way as the younger one, with anatomical pulmonary resection and radical lymphadenectomy. In fact, we believe that implementing preoperative cardiologic studies and redefining selective respiratory criteria specifically for elderly improve surgical results.