Esophageal cancer resection in the elderly

Thomas, Philippe; Doddoli, Christophe; Neville, Phillippa J.; Pons, José Antonio; Lienne, P.; Giudicelli, R; Giovannini, M; Seitz, Julia; Fuentes, Pedro Juan Barrios

doi:10.1016/s1010-7940(96)80394-0

Cited by 91 publications

(59 citation statements)

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“…Past reports [14] announced disappointing results for esophagectomy in the elderly, both because of encountered worse postoperative outcomes and perceived small survival benefit. 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).…”

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%

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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: Introduction and Aim Of The Studymentioning

confidence: 99%

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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“…26,31,[34][35][36][37][38][39][40] There does appear to be an increase in overall mortality and a decrease in OS with advancing age. 39 However, when adjusted for comorbidities, the outcomes are similar across age groups.…”

Section: Surgery and Neoadjuvant Therapymentioning

confidence: 96%

The Impact of Age on Morbidity and Mortality following Esophagectomy for Esophageal Cancer

2013

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“…However, this surgical procedure is associated with 40-50% risk of major complications and mortality rate of 3-5% at high-volume centers and up to 20% at low-volume hospitals [4][5][6][7][8][9][10]. Photodynamic therapy (PDT) offers an alternative nonsurgical outpatient procedure that eliminates dysplasia and superficial cancer and reduces length of Barrett's mucosa while reducing risks compared to esophagectomy [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Porfimer sodium photodynamic therapy for management of Barrett's esophagus with high‐grade dysplasia

Panjehpour

Overholt

2006

Lasers Surg Med

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Porfimer sodium photodynamic therapy (ps-PDT) for Barrett's esophagus is a powerful endoscopic treatment that can eliminate high-grade dysplasia (HGD) and Barrett's mucosa and reduce the risk of development of cancer in these patients. Ps-PDT typically results in destruction of Barrett's esophagus in the majority of the treated area. However, residual small island of Barrett's mucosa may persist after PDT. Therefore, adjuvant thermal ablation should be available during follow-up endoscopies for ablation of residual islands of Barrett's mucosa. PDT should be applied concurrent with effective proton pump inhibitor therapy. This article provides a practical guide for application of porfimer sodium balloon PDT for management of Barrett's esophagus with HGD. Recommendations are provided for patient selection and screening, delivery of PDT to include light dosimetry, methodology for follow-up endoscopies, as well as discussing the potential side effects and complications.

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Esophageal cancer resection in the elderly

Abstract: These data suggest that esophagectomy can be performed safely in selected septuagenarian patients, thus allowing a substantial survival with excellent functional status in a portion of these patients.

Cited by 91 publications

References 0 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☆

The Impact of Age on Morbidity and Mortality following Esophagectomy for Esophageal Cancer

Porfimer sodium photodynamic therapy for management of Barrett's esophagus with high‐grade dysplasia

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