Mediastinal lymphadenectomy in elderly patients with non-small-cell lung cancer

OBJECTIVES: The progressive ageing of the population is accompanied by an increasing incidence of cancer. Our objective was to compare mediastinal lymphadenectomy performed in the surgical treatment of non-small-cell lung cancer (NSCLC) patients between >= 70 and <70. METHODS: We performed a retrospective single-centre case-control study, including 80 patients >= 70 years of age, surgically treated for NSCLC between January 2008 and December 2010, matched 1: 1 to 80 younger controls on gender, American Society of Anesthesia score, performance status and histological subtype of the tumour. The number and type of dissected hilar/intrapulmonary and mediastinal lymph node stations as well as the number of resected lymph nodes were compared between the two age groups. RESULTS: The type of pulmonary resection was significantly different between the two groups (P = 0.03): pneumonectomy 6% (n = 5) for patients >= 70 vs 12% (n = 10) for patients <70, lobectomy 85 (n = 68) vs 65% (n = 52), bilobectomy 1 (n = 1) vs 2% (n = 2) and sublobar resection 7 (n = 6) vs 20% (n = 16). There was no significant difference in type of mediastinal lymphadenectomy (radical vs sampling; P = 0.6). Elderly patients presented a more advanced N status of lymph node invasion than younger controls (P = 0.02). The number and type of dissected lymph node stations and the number of lymph nodes were not significantly different between the two age groups (P = 0.66 and 0.25, respectively). The mean number of metastatic lymph nodes was higher in patients >= 70 (2.3 vs 1.3 in patients <70; P = 0.002). Lymph node ratio between metastatic and resected lymph nodes was higher in elderly patients (0.11 vs 0.07 in younger controls; P = 0.009). CONCLUSIONS: Lymph node involvement in surgically treated NSCLC was more significant in elderly patients >= 70 than in younger patients presenting comparable clinical and histopathological characteristics, and undergoing a similar lymphadenectomy.