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

McLoughlin, James M.; Lewis, James M.; Meredith, Kenneth

doi:10.1177/107327481302000208

Cited by 35 publications

(26 citation statements)

References 49 publications

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“…Age has been demonstrated in several studies to correlate with higher rates of morbidity and mortality as well as worse survival (16)(17)(18)(19)(20) (16). Several other studies, however, have found that when adjusted for comorbid conditions, age itself is not a predictor of post-operative morbidity (2,(21)(22)(23)(24)(25)(26). In a review of 685 patients undergoing esophagectomy between 1994 and 2012 at a single institution cancer center, McLoughlin et al found that the only significant predictor of overall survival and disease free survival on multivariate analysis was neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 85%

“…Surgical resection is an integral part of the treatment algorithm for early stage and locally advanced esophageal cancer. Unfortunately, the morbidity associated with esophagectomy can be high and is estimated in the literature to be between 25% and 50% (2,13,14). Pulmonary and cardiovascular complications such as atelectasis, pneumonia, and atrial fibrillation, in addition to wound infection, anastomotic leak, and chylothorax are among the most commonly seen post-operative complications and may increase the risk of mortality (13,15).…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal cancer continues to increase in incidence worldwide (1)(2)(3)(4). In the United States in 2013 there were 17,990 new cases of esophageal cancer and 15,210 deaths (4).…”

Section: Introductionmentioning

confidence: 99%

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Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

Abbott

Ström

Saeed

et al. 2014

JCO

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Objective: Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization. We sought to examine the impact of age on outcomes in patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL).Methods: A retrospective review of all patients undergoing RAIL from 2009-2013 was conducted.Statistical analysis was performed for the entire cohort and by stratifying patients into three age cohorts:≤49, 50-69, ≥70. Results:We identified 134 patients and found no statistically significant difference for operative time, length of hospitalization, adverse events (AE), or mortality. There was a higher median blood loss (150 cc) seen in cohorts 1 (50-600 cc) and 3 (50-400 cc) compared to cohort 2 [100 (range, 25-400) cc; P<0.01]. The overall AE rate was 10% (cohort 1), 22% (cohort 2), 35% (cohort 3), P=0.13. There were 5 (4%) leaks and 2(1.5%) deaths, but this was not significantly different between cohorts (P=0.40, P=0.91, respectively).Conclusions: RAIL is a safe surgical technique for use in an aging patient population. There was no increased risk of AE or death in the elderly patients compared to younger patients undergoing the robotic approach.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

Abbott

Ström

Saeed

et al. 2014

JCO

Self Cite

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“…The overall morbidity for esophagectomy is estimated to range between 25% and 50% 28 . Although some surgical series suggest that medical comorbidities, rather than actual age, are the most important factors in predicting perioperative morbidity and mortality 26,27,29 , advanced age appears to be an independent risk factor for perioperative mortality in other reports 8,30 .…”

Section: Discussionmentioning

confidence: 99%

“…In our study, age was not found to be significantly associated with os on either univariate or multivariate analysis. Some studies have also suggested that, after careful adjustment for comorbidities, age itself has no effect on survival in patients with esophageal cancer 26,27 .…”

Section: Discussionmentioning

confidence: 99%

Management and Outcomes of Localized Esophageal and Gastroesophageal Junction Cancer in Older Patients

Biagi

Banashkevich

et al. 2015

Current Oncology

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Cost‐effectiveness of chemoradiation followed by esophagectomy versus chemoradiation alone in squamous cell carcinoma of the esophagus

2019

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Background: Standard treatment for locally advanced esophageal cancer usually includes a combination of chemotherapy, radiation, and surgery. In squamous cell carcinoma (SCC), recent studies have indicated that esophagectomy after chemoradiation does not significantly improve survival but may reduce recurrence at the cost of treatment-related mortality. This study aims to evaluate the cost-effectiveness of chemoradiation with and without esophagectomy. Methods: We developed a decision tree and Markov model to compare chemoradiation therapy alone (CRT) versus chemoradiation plus surgery (CRT+S) in a cohort of 57-year-old male patients with esophageal SCC, over 25 years. We used information on survival, cancer recurrence, and side effects from a Cochrane meta-analysis of two randomized trials. Societal utility values and costs of cancer care (2017, USD) were from medical literature. To test robustness, we conducted deterministic (DSA) and probabilistic sensitivity analyses (PSA). Results: In our base scenario, CRT resulted in less cost for more quality-adjusted life years (QALYs) compared to CRT+S ($154 082 for 1.32 QALYs/patient versus $165 035 for 1.30 QALYs/patient, respectively). In DSA, changes resulted in scenarios where CRT+S is cost-effective at thresholds between $100 000-$150 000/ QALY. In PSA, CRT+S was dominant 17.9% and cost-effective at willingness-topay of $150 000/QALY 38.9% of the time, and CRT was dominant 30.6% and costeffective 61.1% of the time. This indicates that while CRT would be preferred most of the time, variation in parameters may change cost-effectiveness outcomes. Conclusions: Our results suggest that more data is needed regarding the clinical benefits of CRT+S for treatment of localized esophageal SCC, although CRT should be cautiously preferred. K E Y W O R D Schemoradiotherapy, cost-effectiveness analysis, economic evaluation, esophageal squamous cell carcinoma, esophagectomy, Markov process SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section.How to cite this article: Salcedo J, Suen S-C, Bian SX. Cost-effectiveness of chemoradiation followed by esophagectomy versus chemoradiation alone in squamous cell carcinoma of the esophagus. Cancer Med.

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

Abstract: Background: In patients with esophageal cancer, treatment decisions often involve a balance between a high-risk procedure and the chance for long-term benefi t. The decision

Cited by 35 publications

References 49 publications

Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

Management and Outcomes of Localized Esophageal and Gastroesophageal Junction Cancer in Older Patients

Cost‐effectiveness of chemoradiation followed by esophagectomy versus chemoradiation alone in squamous cell carcinoma of the esophagus

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