Surgical Outcome of Elderly Patients 75 Years of Age and Older with Thoracic Esophageal Carcinoma

Shimada, Hideaki; Shiratori, Tooru; Okazumi, S.; Matsubara, Hisahiro; Shuto, Kiyohiko; Akutsu, Yasunori; Narushima, Kazuo; Nabeya, Yoshihiro; Hayashi, Hideki; Ochiai, Takenori

doi:10.1007/s00268-007-0606-y

Cited by 23 publications

(16 citation statements)

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“…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. Less has been published for patients over 75 or more [15][16][17]. Our aim was to investigate this 'very old' subset of patients, thus our cohort is composed of 76 years old and over patients, with a mean age of 78.9 and a number of octogenarians as high as 38 (35.1%).…”

Section: Discussionmentioning

confidence: 99%

“…There is an apparent contradiction in literature reports: on one hand well-designed risk analysis studies accuse age of being an independent bad prognosticator for postoperative morbidity [24], mortality [24,25] and long-term survival [16], on the other hand other studies, particularly those with direct comparisons of older versus younger populations [5,6,8,[10][11][12][13]17], refute these conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…If esophagectomy for this group of patients is nowadays accepted, less is reported on patients over 75 [15][16][17]. This study focuses on the short-and long-term outcome after esophagectomy for cancer of the esophagus and gastro-esophageal junction in patients 76 years old and over.…”

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: Discussionmentioning

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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“…The patient's age, multiple comorbidities, and poor performance status often become critical fatal issues for the patients during and after surgery or CRT/RT. Therefore, it is very important to evaluate the comorbidity carefully when determining the additional treatments (30)(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

et al. 2015

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Objective The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients. Methods The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients. Results Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapsefree survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities. Conclusion Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ! submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.

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“…D'autres séries font état d'une augmentation des morbidités postopératoire pulmonaire et cardiaque chez les patients âgés, mais d'une mortalité postopératoire et d'une survie spécifique comparable aux patients plus jeunes [4,33,44]. La mortalité postopératoire varie de 4,7 à 21 % [4,44,57], mais la sélec-tion des malades et la spécialisation des équipes avec notamment une amélioration de la performance des soins périopératoires permettent d'obtenir actuellement des taux plus proches de 5 % [50]. Les complications les plus fréquentes après résection oesophagienne pour cancer sont respiratoires, cardiaques et anastomotiques ; les deux premières étant plus fréquen-tes parmi les patients âgés [37].…”

Section: Traitement Des Tumeurs Résécablesunclassified

Prise en charge des carcinomes oesogastriques, pancréatiques et hépatocellulaires du sujet âgé

et al. 2011

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Surgical Outcome of Elderly Patients 75 Years of Age and Older with Thoracic Esophageal Carcinoma

Abstract: Elderly patients who underwent an esophagectomy in the later period appeared to manifest less neoadjuvant treatment, less surgical stress, fewer postoperative complications, and a better long-term survival than those treated in the earlier period.

Cited by 23 publications

References 30 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☆

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

Prise en charge des carcinomes oesogastriques, pancréatiques et hépatocellulaires du sujet âgé

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