Surgical resection of lung cancer in the elderly.

Assessment for thoracic surgery in elderly patients should be based on physiologic rather than chronologic age. Thoracic surgery has been shown to be safe in selected elderly patients, and age should not be a contraindication to a therapy that offers the best chance of cure for patients with early-stage cancer. A targeted preoperative assessment can help individualize the risk of morbidity and mortality for each patient, and thus provide both surgeon and patient with the information needed for operative decision making. Operative interventions in the elderly require coordinated attention to the specific requirements of the aged. Specialized multidisciplinary care provided by primary care physicians, geriatric specialists, cardiologists, oncologists, surgeons, anesthetists, nurses, physical therapists, and nutrition specialists optimizes care for the elderly patient undergoing thoracic surgery. Careful selection of patients for surgery has contributed to the improvement in operative mortality over time, and refinements in preoperative testing should continue this trend in the future. The goal is to provide surgery to the maximum number of patients at the minimal cost of mortality and loss of independence.