The Influence of Age on Complications and Overall Survival After Ivor Lewis Totally Minimally Invasive Esophagectomy

Abstract

Background The number of elderly patients suffering from esophageal cancer is increasing, due to an increasing incidence of esophageal cancer and increasing life expectancy. However, the effect of age on morbidity, mortality, and survival after Ivor Lewis total minimally invasive esophagectomy (TMIE) is not well known. Methods A prospectively documented database from December 2010 to June 2017 was analyzed, including all patients who underwent Ivor Lewis TMIE for esophageal cancer in three Dutch high-volume esophageal cancer centers. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Baseline patient characteristics and perioperative data were included. Surgical complications were graded using the Clavien-Dindo scale. The primary outcome was postoperative complications Clavien-Dindo ≥ 3. Secondary outcome parameters were postoperative complications, in-hospital mortality, 30- and 90-day mortality and survival. Results Four hundred and forty-six patients were included, 357 in the younger and 89 in the elderly group. No significant differences were recorded regarding baseline patient characteristics. There was no significant difference in complications graded Clavien-Dindo ≥ 3 and overall complications, short-term mortality, and survival. Delirium occurred in 27.0% in the elderly and 11.8% in the younger group ( p < 0.001). After correction for baseline comorbidity this difference remained significant ( p = 0.001). Median hospital length of stay was 13 days in the elderly and 11 days in the younger group ( p = 0.010). Conclusions Ivor Lewis TMIE can be safely performed in selected elderly patients without increasing postoperative morbidity and mortality.

Risk factors for delirium after esophagectomy

“…However, past studies have noted rates of delirium vary with age after the performance of the same type of esophagectomy (eg, Ivor Lewis). 30 Finally, of note, our study identified different lab values associated with delirium such as elevated WBC and AST/SGOT but we did not find statistical differences in values of BMI or albumin which have been noted after other surgical procedures types to be positively associated with delirium. 27 It is important to note that while elevated WBC and AST and INR are associated with delirium, these makers may represent a subclinical preoperative infection or underlying cirrhosis and potential for hepatic encephalopathy development that was not accounted for.…”

“…We did not further analyze variables between patients undergoing each procedure. However, past studies have noted rates of delirium vary with age after the performance of the same type of esophagectomy (eg, Ivor Lewis) …”

Outcomes of curative esophageal cancer surgery in elderly: A meta-analysis

“…However, these three meta-analyses did not include studies on MIE, and excluded studies that used other age thresholds. In contrast, recent individual studies that compared older with younger patients who underwent MIE showed comparable rates of anastomotic leak as well as 30-d mortality[ 11 - 13 ]. Regarding pulmonary and cardiac complications, however, results are conflicting.…”

Strategies to prevent anastomotic leakage after esophagectomy and gastric conduit reconstruction

“…In addition, in patients ≥ 75 years, the nutritional status is often impaired [27] and the sarcopenia rate is higher [28,29]. However, none of the prospective cohort studies comparing younger (< 75 years) and older (≥ 75) cohorts found an association between age and postoperative morbidity or mortality [27,30].…”