Short and long-term outcomes after esophagectomy for cancer in elderly patients
Authors: Tapias, LF; Muniappan, A; Wright, CD; Gaissert, HA; Wain, JC; Morse, CR; Donahue, DM; Mathisen, DJ; Lanuti, M
Annals of Thoracic Surgery.
HERO ID: 1519066
BACKGROUND: As worldwide life expectancy rises, the number of candidates for surgical treatment of esophageal . . .
BACKGROUND: As worldwide life expectancy rises, the number of candidates for surgical treatment of esophageal cancer over 70 years will increase. This study aims to examine outcomes after esophagectomy in elderly patients.
METHODS: Retrospective review of 474 patients undergoing esophagectomy for cancer during 2002-2011. 334 (70.5%) patients were <70 years old (group A), 124 (26.2%) 70-79 years (group B) and 16 (3.4%) ≥80 years (group C). We analyzed the effect of age on outcome variables including overall and disease specific survival.
RESULTS: Major morbidity was observed to occur in 115 (35.6%) patients of group A, 58 (47.9%) of group B and 10 (62.5%) of group C (p=0.010). Mortality, both 30- and 90-day was observed in 2(0.6%) and 7(2.2%) of group A, 4(3.2%) and 7 (6.1%) of group B, and 1(6.3%) and 2(14.3%) of group C, respectively (p=0.032 and p=0.013). Anastomotic leak was observed in 16(4.8%) patients of group A, 6(4.8%) of group B and 0(0%) of group C (p=0.685). Anastomotic stricture (defined by the need for ≥2 dilations) was observed in 76(22.8%) of group A, 13(10.5%) of group B and 1(6.3%) of group C (p=0.005). Five-year overall and disease specific survival was 64.8% and 72.4% for group A, 41.7% and 53.4% for group B, 49.2% and 49.2% for group C patients (p=0.0006), respectively.
CONCLUSIONS: Esophagectomy should be carefully considered in patients 70-79 years old and can be justified with low mortality. Outcomes in octogenarians are worse suggesting esophagectomy be considered on a case by case basis. Stricture rate is inversely associated to age.