Surgical treatment of primary multiple lung cancer in elderly and senile patients

Objective. To evaluate early and long-term outcomes of surgical treatment for primary multiple lung cancer (PMLC) in elderly and senile patients and to characterize key aspects of perioperative management. Material and methods. A retrospective single-center study included 12 patients with verified PMLC who underwent surgery between 2010 and 2022. They were classified as elderly (60—75 years; n=9) or senile (76—85 years; n=3) according to the WHO classification. PMLC was confirmed using the Martini—Melamed criteria modified by Antakli and the Warren—Gates criteria. Patients underwent anatomical (lobectomy, bilobectomy, pneumonectomy) or sublobar (segmentectomy, wedge resection) lung resections, predominantly via video-assisted thoracic surgery. Postoperative complications were assessed using the Clavien—Dindo classification. Disease-free and overall survival after the second surgery were analyzed using the Kaplan—Meier method. Results. R0 resection was achieved in all patients. After surgery for the second primary lesion, postoperative complications occurred in 75% of cases. The most common events were prolonged air leak, residual pleural cavities, COPD exacerbation, and cardiac arrhythmias. No in-hospital mortality was observed. Mean postoperative hospital-stay was 8.4±2.1 days after the first surgery and 10.2±2.5 days after the second surgery. Following the second resection, 1-, 3- and 5-year disease-free survival rates were 93.9%, 84.4%, and 67.6%, respectively. Overall survival rates were 99.6%, 87.4%, and 76.6%, respectively. No significant differences in survival were found between lobectomy and sublobar resections. These findings should be interpreted as descriptive due to small sample size. Conclusion. In carefully selected elderly and senile patients, surgical treatment of PMLC provides acceptable rates of postoperative morbidity and 5-year survival comparable to published data. Anatomical resections are preferable in patients with sufficient functional reserves. In those with limited cardiopulmonary function, sublobar resections are an acceptable alternative.