Nostra esperienza nel trattamento chirurgico delle neoplasie polmonari nei pazienti anziani

Every surgical treatment in the elderly could appear particularly difficult, especially when treating thoracopulmonary diseases, because of the frequent presence of associated illness, as chronic respiratory failure and/or miocardiosclerosis. The Authors examine their experience regarding pulmonary neoplasms observed at the Clinica Chirurgica of the University of Perugia, from May 1, 1986 to December 31, 1989, based on 181 patients 55 of whom over 70 years old. All the patients were studied in order to accurately stage the tumor and defining the cardiopulmonary and respiratory status, thus avoiding any surgical procedure in patients with an unacceptable high operative risk or with an advanced stage neoplasm. Standard screening tests were used to study pulmonary function in each patient; patients presenting abnormal or borderline activity underwent further examination, as Xenon ventilation test, perfusion test and ventilation perfusion rate, pulmonary closure volume assessment; we found these tests to be useful to judge operability and resectability. 17 patients were excluded from approach, the remaining being operated and strictly monitored. Intraoperative and postoperative monitoring included CVP, Pulmonary Artery pressure with free or blocked catheter, 02 saturation and continuous peripheral arterial pressure. The use of described techniques al. lowed us to reduce post operative complications even in high risk patients.