Thursday, December 29, 2005

Another 80 year old with a lung lesion.

Remember this post about the 80-ish year old with a solitary lesion and whether his age should preclude w/u for possible resection? Well, what would you do with this 82 year old with a hilar (i.e. unresectable) mass that is (as of yet) without diagnosis (i.e. how aggressive would you be with the work-up)?

Here's his CT:

6 comments - CLICK HERE to read & add your own!:

Baleeiro said...

I think it still depends on level of function and the patients wishes and understading of the problem. Even the fact that it is unresectable, if it is "only" IIIB and not stage IV disease you can achieve complete regression and a few good disease-free years if this is an otherwise healthy, active octogenarian.

Mike L said...

Is this thing extending in the pulmonary artery? It looks like a T2 lesion on the cut you provide.
If not, I think it would be N1 lesion. That would make him IIB and resectible.
Is he not physiologically resectible?

I second the need for a diagnosis. Chemo and XRT offer improved outcomes (but not cure) and should be explored with your patient.

Jennings said...

Sorry I didn't include the cut showing a likely station 7 node. But otherwise I do agree that the theme is that age shouldn't matter in and of itself.

janus said...

In my opinion and in my experience,if the patient wants and hi is operable, It is right to resect.

janus said...
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Eugene O said...

I agree with Baleeiro. When deciding a treatment strategy, the physiologic rather than chronological age should be carefully assessed as well as comorbidities, social support, patient’s wishes, etc. But many surgeons hate two-digit operative mortality rate as seen in this study.
http://ejcts.ctsnetjournals.org/cgi/content/abstract/8/9/453