Outcomes of Video-Assisted Thoracoscopic Lobectomy in Octogenarians Following Enhanced Recovery After Surgery Protocols

Objectives: The improvements from minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols have enabled more octogenarians to be considered for curative treatment of early-stage lung cancer. However, evidence on short-term outcomes after ERAS-guided Video-Assisted Thoracoscopic Surgery (VATS) lobectomy in this age group remains limited. The aim was to evaluate perioperative outcomes and assess specific challenges in octogenarians undergoing VATS lobectomy following a well-established ERAS-protocol. Methods: We conducted a retrospective observational study of consecutive adults undergoing VATS lobectomy within an ERAS program from 2009 to 2024. All patients followed standardized care and followed an ERAS protocol. Patients aged ≥80 years underwent an additional preoperative risk assessment. Results: Among 4,602 patients, 335 (7.3%) were octogenarians (median age 82 years, IQR 81–83). Median length of stay was one day longer among octogenarians (4 (IQR: 2–7) vs 3 days (IQR: 2–6), p = 0.004). Overall complication rates were comparable between octogenarians and younger patients, except for postoperative atrial fibrillation (octogenarians 12% vs 7.6%, p = 0.012). Within 30 days, 40 octogenarians (11.9%) were readmitted, most commonly for pneumonia (30%), pneumothorax (25%), and pleural effusion (20%). 30-day mortality was not statistically different between octogenarians and younger patients (octogenarians 1.8% vs 1.2%, p = 0.29). The number of octogenarians undergoing VATS lobectomy has increased from 2.5% of all patients in 2009 to 11.7% in 2024. Conclusion: VATS lobectomy within an ERAS framework appears safe and feasible in carefully selected octogenarians, yielding acceptable short-term outcomes. Chronological age alone should not preclude surgical treatment.