The Short- and Long-term Outcomes of Esophagectomy for Esophageal Cancer in Patients Older than 75 Years

Abstract

Background: The short-and long-term outcomes of esophagectomy for esophageal cancer were fully evaluated in patients older than 75 years of age. Patients and Methods: The present study selected patients who received esophagectomy for esophageal cancer. Patients were divided into non-elderly patients [age <75 years (nonelderly group)] and elderly patients [age ≥75 years (elderly group)]. The postoperative surgical morbidity, postoperative 30-days mortality, recurrence-free survival (RFS), and overall survival (OS) rates were evaluated between the nonelderly group and elderly group. Results: One hundred twenty-two patients were evaluated in this study. Ninetyeight patients and 24 patients were classified into the nonelderly group and elderly group, respectively. The postoperative surgical complication rates in the non-elderly and elderly groups were 71.4% and 75.0%. There was not a statistically significant difference between the two groups (p=0.710). Mortality was observed in 1 patient in the elderly group (4.2%) due to cardiovascular disease. Significant differences were observed in the five-year OS and RFS rates of the elderly and non-elderly groups (55.4% vs. 29.7%, p=0.0017 and 42.2% vs. 21.2%, p=0.0334, respectively). Conclusion: Although the rate of postoperative surgical complications after esophagectomy for esophageal cancer was almost equal in the elderly and the non-elderly patients, significant differences were observed in the mortality and long-term outcomes of the two groups. Thus, the surgical strategy and perioperative care must be carefully planned for esophageal cancer patients older than 75 years of age.

Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis

“…Among the 19 studies assessing anastomotic leakage for EP versus YP, none revealed a difference in the incidence of this complication ( Table 1 ) [ 14 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Anastomotic leakage rates presented considerable variability, reaching 25–37.5% for series with cervical anastomoses [ 31 , 35 , 43 ]. Schweigert et al reported a significantly increased postoperative mortality (OR = 8.24, p = 0.025) for EP compared to YP who present an anastomotic leakage [ 37 ].…”

“…Thirty studies assessed long-term survival among EP compared to YP treated by surgery for esophageal cancer (Table 2). Fourteen studies found a significantly shorter overall survival for EP [25,29,32,34,36,38,40,43 Eleven studies reported disease-free or disease-specific survival (Table 2). Only four authors found a disease-free survival advantage for YP [29,38,43,49], suggesting that no robust suggestions for earlier cancer recurrence in EP can be made.…”

The Clinical Impact of the Age-adjusted Charlson Comorbidity Index on Esophageal Cancer Patients Who Receive Curative Treatment

“…Recently, the number of the elderly esophageal cancer patients has been rapidly growing. Elderly esophageal cancer patients generally have co-morbidities and age-related physiological problems (6)(7)(8). Previous reports have shown that the postoperative surgical complication rates after esophagectomy are 30% to 70%, and the mortality rate is 1%-5% (9)(10)(11)(12).…”

Photodynamic Therapy Using Talaporfin Sodium for Local Failure after Chemoradiotherapy or Radiotherapy for Esophageal Cancer: A Single Center Experience

“…Recognizing these limitations, the implications of our report are that this treatment was able to reproduce the results of the phase II trial in various real-world settings without difficulty and that this therapy can be used flexibly even in elderly patients. To date, the aging of population has been progressing and elderly patients with esophageal cancer are more likely to be treated with CRT or RT alone, instead of surgery, for comorbidities and treatment risks [29,30]. Salvage PDT is reported to be a safer and more effective treatment option than other minimally invasive treatments such as re-irradiation or endoluminal brachytherapy in elderly patients [31,32].…”