Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

Ma, Jie; Zhu, Wei; Wang, Yun; Zhao, Youjin; Liu, Lunxu; Kou, Yingli; Zhou, Qinghua

doi:10.3748/wjg.v12.i8.1296

Cited by 39 publications

(56 citation statements)

References 18 publications

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“…More recent studies outlined acceptable results, with well selected aged patients showing neither significantly different postoperative mortality rate nor poorer long-term survival than younger counterparts after esophagectomy for cancer [5,6,8,[10][11][12][13]] (see Table 6). The vast majority of these studies set the cut-off to define a patient 'elderly' at the age of 70, the analyzed populations thus having a mean age around 73.…”

Section: Discussionmentioning

confidence: 99%

“…It is always difficult to compare different series on the basis of comorbid conditions because of the various definitions and different selection criteria. However a higher rate of comorbidities in elderly compared to younger patients has been frequently reported [5,6,[8][9][10]16] and the shortening in functional reserve typical of the aged population is considered responsible for the enhanced risk of postoperative medical complications (mainly cardiopulmonary) reported in some series [6,8,10] (see Table 6), Factors affecting postoperative mortality. Table 6 Overview of some of the most important studies published in the last decade comparing surgical outcome after esophagectomy for cancer of an older versus a younger population…”

Section: Discussionmentioning

confidence: 99%

“…There is no established cut-off to define a patient as 'elderly' in relation to surgery, but most studies available so far set the age limit at 70 [5][6][7][8][9][10][11][12][13][14]: all these studies conclude that surgical resection is justified in selected aged patients, mainly those aged between 70 and 75 years. If esophagectomy for this group of patients is nowadays accepted, less is reported on patients over 75 [15][16][17].…”

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

See 2 more Smart Citations

Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

Internullo

Moons

Nafteux

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: Though the surgical treatment of esophageal cancer is increasingly accepted for elderly people defined as aged over 70 years, less is reported about the results in patients over 75. This study is a single institution retrospective analysis of outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Methods: All consecutive patients 76 years old and over undergoing curative esophagectomy for cancer in the period 1991-2006 were analyzed as to comorbidities, outcome and long-term survival. All the data had been prospectively collected in a database. Postoperative mortality risk was assessed by P-POSSUM and O-POSSUM score for in-hospital mortality and by the recently published Steyerberg's score system [Steyerberg EW, Neville BA, Koppert LB, Lemmens VEPP, Tilanus HW, Coebergh JWW, Weeks JC, Earle CC. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277-84.] for 30-day mortality. Five-year survival was compared to the standardized survival in the general population. Results: One hundred and eight patients fulfilling the abovementioned criteria were found (76 males and 32 females, mean age 79.5 years, mean standardized life-expectancy: 7.36 years). Among them, 69% had esophageal tumors and 31% GEJ tumors. The predominant histology was adenocarcinoma (74%). Eighty-six (79.6%) presented with one or more major comorbidities or a history of previous major upper-GI surgery, potentially affecting the surgical outcome. All underwent resection with curative intent (R 0 83.3%, R 1 12%, R 2 4.6%). The overall postoperative morbidity rate was 51.9%, pulmonary complications (37%) being the most frequent. Postoperative mortality, mainly due to cardiopulmonary complications, was 7.4%, which was consistent with that predicted by P-POSSUM score (7.2%) and lower than that predicted by O-POSSUM score (15.1%). Thirty-day mortality was 5.5%, being consistent with that predicted by the Steyerberg's score (6.8%). Overall 5-year survival was 35.7%, while R 0 overall survival 42% and cancer specific R 0 survival 51.7%. Conclusions: Patients 76 years old and over with esophageal or GEJ cancer should not be denied surgery solely on the basis of age. Outcome and long-term results in the selected elderly are not differing from those reported for younger patients. However, despite thorough preoperative assessment being applied in the selection of the candidates for surgery, a practical and reliable individual riskanalysis stratification is still lacking. #

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

See 1 more Smart Citation

Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

Internullo

Moons

Nafteux

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…In several studies, the influence of old age was investigated [44][45][46][47][48][49][50][51][52][53][54][55][56] . In a minority of studies, older age was associated with an unfavourable postoperative outcome 44;49;52;53;55;56. The use of a risk score may be a quality indicator.…”

Section: Patient Selectionmentioning

confidence: 99%

Quality-of-care indicators for oesophageal cancer surgery: A review

Staal

Wouters

Boot

et al. 2010

European Journal of Surgical Oncology

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“…However, most series indicate that a significantly smaller proportion of elderly patients diagnosed with oesophageal cancer is actually referred for oesophagectomy compared to younger patients (Sabel et al, 2002;Bonavina et al, 2003), indicating significant patient selection. Few series report patients' coexisting medical conditions (Poon et al, 1998, Ma et al, 2006. Most series indicate comparable to higher rates of post-operative morbidity, and comparable rates of post-operative mortality in patients over the age of 70 referred for oesophagectomy (Jougon et al, 1997;Kinugasa et al, 2001).…”

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confidence: 99%

Combined modality chemoradiation in elderly oesophageal cancer patients

et al. 2007

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We present a single institution experience with 5-FU, mitomycin-C based chemoradiation for the primary treatment of elderly patients with oesophageal cancer. Twenty-five patients with a median age of 77 years (range 66 -88) with a diagnosis of stage II -III squamous cell or adenocarcinoma of the oesophagus were treated at Memorial Sloan Kettering from 1996 to 2001 with two cycles of concurrent 5-FU, mitomycin-C and 50.4 Gy. Owing to age and comorbidity, these patients were not considered surgical candidates. The Charlson comorbidity score was used to evaluate patient comorbidity. Nine patients (36%) experienced grade 3 -4 haematologic toxicity. Of the 23 patients evaluable for response, 17 patients (68%) had a negative post-treatment endoscopy and CT scan without evidence of progressive disease. Eleven patients (44%) are alive and 10 (40%) remain without evidence of recurrent or progressive oesophageal cancer at a median follow-up of 35 months. The median overall survival was 35 months and 2-year survival 64%. There was no significant difference in overall survival between Charlson score p2 and those with a score X2 (P ¼ 0.10). Similar survival was observed for patients with adenocarcinoma or squamous carcinoma. Primary chemoradiation with two cycles of 5-FU, mitomycin-C, and 50.4 Gy in elderly patients is an active regimen with moderate toxicity, despite the advanced age and heavy comorbidity burden of this cohort. Patients with local/regional oesophageal cancer with adequate functional status should not be excluded from potentially curative treatment based on age alone.

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Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

Cited by 39 publications

References 18 publications

Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

Quality-of-care indicators for oesophageal cancer surgery: A review

Combined modality chemoradiation in elderly oesophageal cancer patients

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