S120 Outcomes for lung cancer surgery in octogenarians. Do they do worse than their younger cohort

Introduction and Objectives Management of Octagenarians with lung cancer is an ever-increasing clinical scenario, with surgery often regarded as high risk. Understanding the short and long term outcomes of lung cancer surgery in this cohort is fundamental to refine our assessment and management in this group. We aimed to assess the length of stay (LOS) on intensive care, in hospital, postoperative morbidity and mortality of lung cancer surgery in this group. Methods A retrospective analysis of all of patients aged 80 and over undergoing lung cancer surgery at our tertiary cardiothoracic centre between 2015 and 2018 was conducted. 176 patients were identified and analysed for performance status (WHO-PS), stage, pathological subtype, length of stay (LOS) and mortality at 30, 90 and 365 days. Results 47% of patients were male and 53% female with a mean (SD) age of 82 (2.2). The vast majority (81%) underwent an open procedure. The median LOS in intensive care (ICU) was 1 day (IQR 0–2) with only 1 patient being readmitted to ICU. The median LOS was 6 days (IQR 4–9). Overall 30 day mortality was 3.8% and decreased throughout the years from 6.8% in 2015 to 2.5% in 2018. Survival at 1 year was 86% in 2015 and 95% in 2018. (Table 1) Overall 1 year survival (92.7%) was higher than the all age survival (88.7%) quoted in the national lung cancer audit data (2016).1 The commonest cause of death in this cohort was post-operative complications including aspiration (n=3), hospital acquired pneumonia (n=2) and stroke (n=1). Other causes of death included disease reoccurrence accounting for 31% of all deaths and disease progression. Conclusions Octagenarians who are suitable for surgery with curative intent have short ICU stays, slightly higher than average overall stays but comparable survival rates at 30, 90 and 365 days to their peers, suggesting good selection equates to good outcomes. Streaming lung cancer pathways, refinement of high-risk MDT processes and recognition of the need for pre-operative optimisation with management of co-morbidities and onco-geriatric support has improved this. Reference The National Lung Cancer Audit report 2016. London: RCP; 2016. Royal College of Physicians.