Preoperative assessment and risk factors in the surgical treatment of lung cancer: the role of age.

The incidence of lung cancer in the elderly is increasing in Western countries. This disease represents the second leading cause of cancer death in this age group and it is also responsible for a substantial increment in morbidity and health care costs. Several studies suggested that age per se should not be considered a risk factor for surgical mortality and morbidity in lung cancer patients and access to surgical treatment should not be denied only on the basis of age. Indeed, advanced age may represent an indicator of several factors such as comorbidity or poor physical performance which in turn can increase surgical risk and dramatically reduce life expectancy. Therefore, a careful preoperative assessment of these factors, with particular regard to comorbid conditions (such as cardiovascular and pulmonary diseases or secondary malignancy) is necessary in older adults. In consideration of the need of a multidisciplinary assessment to identify comorbidities and operative risk a close collaboration between pneumologists, radiologists, oncologists, thoracic surgeons, anesthesiologists, cardiologists, geriatric specialists, physical therapists is highly recommended.