Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2024; 12(12): 2040-2049
Published online Apr 26, 2024. doi: 10.12998/wjcc.v12.i12.2040
Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery
Mei-Hua Sun, Liu-Sheng Wu, Ying-Yang Qiu, Jun Yan, Xiao-Qiang Li
Mei-Hua Sun, Xiao-Qiang Li, Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
Liu-Sheng Wu, Jun Yan, School of Medicine, Tsinghua University, Beijing 100084, China
Liu-Sheng Wu, Ying-Yang Qiu, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
Co-first authors: Mei-Hua Sun and Liu-Sheng Wu.
Co-corresponding authors: Xiao-Qiang Li and Jun Yan.
Author contributions: Yan J and Li XQ conceived and designed the study; Qiu YY screened patients to obtain clinical data and data analysis; Wu LS and Sun MH wrote the paper; All authors have read and approved the final draft. Wu LS proposed, designed, and analyzed the data and wrote the first draft of the paper. Sun MH was responsible for patient screening, enrollment, and the collection of clinical data. Both authors have made vital and indispensable contributions to the completion of the project and are therefore qualified to be co-first authors of the paper. As co-corresponding authors, Yan J and Li XQ played an important and indispensable role in project design, data interpretation, and manuscript preparation. Yan J and Li XQ applied for and were successful in obtaining funding for this project. Yan J conceived, designed, and supervised the entire project process. Li XQ assisted and was responsible for data reanalysis and reinterpretation, graphing, comprehensive literature search, preparation, and submission of the current version of the manuscript. The cooperation of Yan J and Li XQ was critical to the publication of this manuscript.
Supported by the Scientific Research Foundation of Peking University Shenzhen Hospital, No. KYQD2021096; the National Natural Science Foundation of China, No. 81972829; and Precision Medicine Research Program of Tsinghua University, No. 2022ZLA006.
Institutional review board statement: The study was approved by the Institutional Review Board of Peking University Shenzhen Hospital, and all patients provided their informed consent before starting the treatment.
Informed consent statement: As it was a retrospective clinical study, all the patients were contacted by telephone to obtain verbal informed consent and it was approved by the ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data collected and analyzed in this study are included in this article, and technical appendix, statistical code, and dataset available from the corresponding author at
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://
Corresponding author: Xiao-Qiang Li, PhD, Assistant Professor, Department of Thoracic Surgery, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Futian District, Shenzhen 518036, Guangdong Province, China.
Received: November 12, 2023
Peer-review started: November 12, 2023
First decision: January 30, 2024
Revised: February 25, 2024
Accepted: March 15, 2024
Article in press: March 15, 2024
Published online: April 26, 2024
Research background

Lung cancer is the leading cause of death worldwide, and non-small cell lung cancer (NSCLC) in the elderly accounts for a significant proportion. With the significant growth of the aging population, the need for surgical treatment of elderly patients has gradually become more prominent. Video-assisted thoracic surgery (VATS) has become an important choice for the treatment of senile NSCLC due to its characteristics of less trauma and rapid recovery. However, current systematic studies on VATS in postoperative recovery in elderly patients are relatively limited. Therefore, an in-depth understanding of the influence of VATS on elderly patients and revealing its potential role in postoperative rehabilitation are of great significance for guiding the individualized treatment of elderly patients with NSCLC and improving surgical results.

Research motivation

The aim of this study was to investigate the potential enhancement of VATS in postoperative recovery in elderly patients with NSCLC.

Research objectives

This study was designed to investigate the clinical outcomes of enhanced recovery after surgery (ERAS) in the perioperative period in elderly patients with NSCLC.

Research methods

We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS (the ERAS group) and 327 elderly NSCLC patients who received routine care (the control group) after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017. After propensity score matching of baseline data, we analysed the postoperative stay, total hospital expenses, postoperative 48-hour pain score, and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.

Research results

After propensity score matching, ERAS significantly reduced the postoperative hospital stay (6.96 ± 4.16 vs 8.48 ± 4.18 d, P = 0.001) and total hospital expenses (48875.27 ± 18437.5 vs 55497.64 ± 21168.63 CNY, P = 0.014) and improved the satisfaction score (79.8 ± 7.55 vs 77.35 ± 7.72, P = 0.029) relative to those for routine care. No significant between-group difference was observed in postoperative 48-h pain score (4.68 ± 1.69 vs 5.28 ± 2.1, P = 0.090) or postoperative complication rate (21.2% vs 27.1%, P = 0.371). Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.

Research conclusions

ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

Research perspectives

We look forward to more large-sample, multicenter studies to validate the recovery benefits of VATS in elderly patients with NSCLC and to further clarify the safety and effectiveness of the surgical technique. At the same time, combined with biological markers and imaging techniques, the specific mechanism of VATS on postoperative inflammatory response, immune function, and quality of life in elderly patients was further studied. With the help of advanced technical means, the individual differences of elderly patients were finely delineated to provide a more accurate basis for personalized surgical treatment. In addition, the long-term efficacy and survival rate of VATS in elderly patients were evaluated through long-term follow-up to comprehensively understand the long-term impact of surgery. These future research directions will provide an in-depth and comprehensive understanding for further promoting the development of surgical treatment for elderly NSCLC.