Protocol for guidelines on the comprehensive perioperative management of elderly patients with lung cancer (2025)_Chinese Journal of Evidence-Based Medicine

Authors：

LI Daiping ¹ , LIANG Rui ¹ , LI Linlong ¹ , WANG Yang ¹ , YANG Zhongli ¹ , CHEN Nan ² , YUE Jirong ¹ , DONG Birong ¹ ,  LIU Lunxu ² ,  GE Ning ¹

1. Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

LIU Lunxu, Email: lunxu_liu@aliyun.com; GE Ning, Email: grace7733@163.com

Keywords：

Elderly; Lung cancer; Perioperative period; Comprehensive management; Protocol

DOI：

10.7507/1672-2531.202505019

Video：

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With the acceleration of population aging in China, the number of elderly patients with lung cancer continues to rise. These patients not only face threats from the tumor itself but also often suffer from multiple chronic diseases and geriatric syndromes, which increase the complexity of perioperative management and surgical risks. To provide standardized perioperative management strategies for elderly lung cancer patients, the guideline aims to reduce postoperative complications and improve patients' quality of life through comprehensive geriatric assessment, comorbidity management, and early identification and intervention of complications. The guideline working group has drafted the "Protocol for Guidelines on the Comprehensive Perioperative Management of Elderly Patients with Lung Cancer (2025)", detailing the development process of the guidelines.

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5.	Korc-Grodzicki B, Downey RJ, Shahrokni A, et al. Surgical considerations in older adults with cancer. J Clin Oncol, 2014, 32(24): 2647-2653.
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7.	Shi J, Wu Z, Wang Q, et al. Clinical predictive efficacy of C-reactive protein for diagnosing infectious complications after gastric surgery. Therap Adv Gastroenterol, 2020, 13: 1756284820936542.
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22.	Wang Y, Keitz S, Briel M, et al. Development of ROBUST-RCT: risk of bias instrument for use in systematic reviews-for randomised controlled trials. BMJ, 2025, 388: e081199.
23.	Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
24.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
25.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
26.	Rostom A, Dubé C, Cranney A, et al. Quality assessment forms. Rockville (MD): Agency for Healthcare Research and Quality (US), 2004.

1. Stieglitz S, Goede V, Schlesinger A. Management of lung cancer in older adults. Z Gerontol Geriatr, 2025, 58(2): 103-108.
2. Inouye SK, Studenski S, Tinetti ME, et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc, 2007, 55(5): 780-791.
3. Decoster L, Kenis C, Schallier D, et al. Geriatric assessment and functional decline in older patients with lung cancer. Lung, 2017, 195(5): 619-626.
4. Tsiouris A, Hammoud ZT, Velanovich V, et al. A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res, 2013, 183(1): 40-46.
5. Korc-Grodzicki B, Downey RJ, Shahrokni A, et al. Surgical considerations in older adults with cancer. J Clin Oncol, 2014, 32(24): 2647-2653.
6. Wong ML, McMurry TL, Schumacher JR, et al. Comorbidity assessment in the national cancer database for patients with surgically resected breast, colorectal, or lung cancer (AFT-01, -02, -03). J Oncol Pract, 2018, 14(10): e631-e643.
7. Shi J, Wu Z, Wang Q, et al. Clinical predictive efficacy of C-reactive protein for diagnosing infectious complications after gastric surgery. Therap Adv Gastroenterol, 2020, 13: 1756284820936542.
8. Park BS, Cho SH, Lee SH, et al. Role of C-reactive protein, white blood cell counts, and serum glucose levels as early predictors of infectious complications after laparoscopic colorectal surgery for colorectal cancer. Am Surg, 2023, 89(12): 5821-5828.
9. 陳旭嬌, 嚴靜, 王建業, 等. 中國老年綜合評估技術應用專家共識. 中華老年病研究電子雜志, 2017, 4(2): 1-6.
10. 中華醫學會腫瘤學分會. 中華醫學會肺癌臨床診療指南(2024版). 中華醫學雜志, 2024, 104(34): 3175-3213.
11. 朱鳴雷, 劉曉紅, 董碧蓉, 等. 老年共病管理中國專家共識(2023). 中國臨床保健雜志, 2023, 26(5): 577-584.
12. World Health Organization. WHO handbook for guideline development. 2nd ed. Vienna: WHO, 2014: 1-167.
13. Schünemann HJ, Wiercioch W, Etxeandia I, 等. 指南2. 0: 為成功制定指南而系統研發的全面清單. 中國循證醫學雜志, 2014, 14(9): 1135-1149.
14. 陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022版). 中華醫學雜志, 2022, 102(10): 697-703.
15. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
16. 拜爭剛, 劉少堃, 黃崇斐, 等. 定性系統評價證據分級工具—CERQual簡介. 中國循證醫學雜志, 2015, 15(12): 1465-1470.
17. Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
18. 楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性、透明性和適用性的評級工具研發. 中華醫學雜志, 2022, 102(30): 2329-2337.
19. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
20. 陳耀龍, 馬艷芳, 周奇, 等. 誰應該參與臨床實踐指南的制訂. 協和醫學雜志, 2019, 10(5): 524-530.
21. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
22. Wang Y, Keitz S, Briel M, et al. Development of ROBUST-RCT: risk of bias instrument for use in systematic reviews-for randomised controlled trials. BMJ, 2025, 388: e081199.
23. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
24. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
25. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
26. Rostom A, Dubé C, Cranney A, et al. Quality assessment forms. Rockville (MD): Agency for Healthcare Research and Quality (US), 2004.

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