Too Old for Surgery? A Case Report of an Octogenarian Patient With Locally Advanced Lung Cancer Achieving Long-Term Survival via Bilobectomy Followed by Adjuvant Targeted Therapy

Abstract

Background

An increasing number of octogenarian patients are being diagnosed with lung cancer, but they are less likely to receive surgery because of fragility. As a result, the optimal management of lung cancer in octogenarians remains unclear. Here we report a case of an octogenarian patient with locally advanced non-small-cell lung cancer (NSCLC) who achieved long-term survival via surgery followed by adjuvant targeted therapy.

Case

An 82-year-old male patient was admitted to our center for lung cancer surgery in April 2020 at West China Hospital, Sichuan University. He was clinically diagnosed with cT2N1M0(cIIB, AJCC 8th edition) lung cancer in the right lower lobe. Because of his good cardiopulmonary function without comorbidities, the patient was scheduled for thoracoscopic surgery. However, due to tumor invasion into the middle lobe and dense adhesions to the bronchus and vessels, the patient underwent conversion to open thoracotomy and finally received bilobectomy with systematic lymph node dissection. The patient recovered uneventfully and was discharged on postoperative day 5. After surgery, the patient was pathologically diagnosed with pT3N2M0(pIIIB) lung adenocarcinoma harboring an EGFR L858R gene mutation and began adjuvant icotinib. The patient progressed with multiple pulmonary metastasis at 13 months after starting icotinib and his liquid biopsy revealed a T790M mutation; he began treatment with the third-generation EGFR-TKI aumolertinib. In the last follow-up in December 2025, the patient remained on aumolertinib therapy and remained alive without progression.

Conclusion

Age alone is not a contraindication for lung cancer surgery and octogenarian patients may tolerate surgical resection following careful preoperative evaluation. Adjuvant targeted therapy may prolong survival in octogenarian lung cancer patients harboring oncogenic driving gene mutation after surgery.