Extended Esophagectomy in Elderly Patients with Esophageal Cancer: Minor Effect of Age Alone in Determining the Postoperative Course and Survival

Abstract

BackgroundElderly patients who undergo esophagectomy for cancer often have a high prevalence of coexisting diseases, which may adversely affect their postoperative course. We determined the relationship of advanced age (i.e., ≥70 years) with outcome and evaluated age as a selection criterion for surgery.MethodsBetween January 1991 and January 2007, we performed a curative-intent extended transthoracic esophagectomy in 234 patients with cancer of the esophagus. Patients were divided into two age groups: <70 years (group I; 170 patients) and ≥70 years (group II; 64 patients).ResultsBoth groups were comparable regarding comorbidity (American Society of Anesthesiologists classification), and tumor and surgical characteristics. The overall in-hospital mortality rate was 6.2% (group I, 5%, vs. group II, 11%, P = 0.09). Advanced age was not a prognostic factor for developing postoperative complications (odds ratio, 1.578; 95% confidence interval, 0.857–2.904; P = 0.143). The overall number of complications was equal with 58% in group I vs. 69% in group II (P = 0.142). Moreover, the occurrence of complications in elderly patients did not influence survival (P = 0.174). Recurrences developed more in patients <70 years (58% vs. 42%, P = 0.028). The overall 5-year survival was 35%, and, when included, postoperative mortality was 33% in both groups (P = 0.676).The presence of comorbidity was an independent prognostic factor for survival (P = 0.002).ConclusionsAdvanced age (≥70 years) has minor influence on postoperative course, recurrent disease, and survival in patients who underwent an extended esophagectomy. Age alone is not a prognostic indicator for survival. We propose that a radical resection should not be withheld in elderly patients with limited frailty and comorbidity.

The effectiveness of transthoracic surgical treatment in elderly patients with esophageal cancer

“…Another factor that increases the number of surgical complications in elderly patients is the presence of comorbid diseases, [5,10] and this was the case for 40.5% of the subjects in our study. Of the three patients for whom mortality was observed, one had diabetes mellitus (DM), hypertension, and deep venous thrombosis, another had suffered from skin cancer, and the other patient had a history of alcohol abuse and smoking.…”

“…Several authors believe that elderly patients are diagnosed in advanced stages due to late-onset symptoms and a longer time interval between onset and diagnosis. [4,5] It has been stated that the life expectancy of elderly esophageal cancer patients is lower than that of young patients. [4,5] Due to the aforementioned reasons, many surgeons prefer palliative management of elderly patients rather than aggressive surgical excision.…”

“…[4,5] It has been stated that the life expectancy of elderly esophageal cancer patients is lower than that of young patients. [4,5] Due to the aforementioned reasons, many surgeons prefer palliative management of elderly patients rather than aggressive surgical excision. [4] Preoperative risk evaluation and estimation of prognostic risk factors for older patients is another controversial topic.…”

“…[4] Preoperative risk evaluation and estimation of prognostic risk factors for older patients is another controversial topic. Some studies [5,6] have detected a strong relationship between advanced age during and/ or after an esophageal resection and a bad prognosis. In older patients, complications are seen more frequently, especially those which involved the cardiac and pulmonary systems.…”

“…Such a system might enable preoperative cardiac and/or pulmonary supportive manipulations; thus, the risk of complications could be reduced. [5] Takahashi et al [7] detected that pulmonary complications are important risk factor in the postoperative 50-day mortality rate of elderly esophageal cancer patients, and they detected no other risk factor of importance related to survival of patients. The stage of cancer and age of the patient were detected as independent predictors for long-term survival after surgery.…”