Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

No abstract

Immune depression after trauma-hemorrhage has been implicated as an important factor in the pathogenesis of sepsis and septic-organ failure. Although recent studies have implicated immune cell apoptosis as an important factor in the evolution of this post-trauma immune suppressed state, neither the initial triggers that induce this response nor the cellular pathways through which these triggering pathways act have been fully defined. Thus, the current study tests the hypothesis that acute splenic and thymic immune cell apoptosis developing after trauma-hemorrhagic shock (T/HS) is due to gut-derived factors carried in intestinal lymph and that this T/HS lymph-induced immune depressed state is mediated through TLR4. The first set of experiments documented that T/HS caused both thymic and splenic immune cell apoptosis as measured by TUNEL and caspase-3 immunohistochemistry and that this increase in apoptosis was totally abrogated by mesenteric lymph duct ligation. In subsequent experiments, mesenteric lymph collected from animals subjected to T/HS or trauma-sham shock (T/SS) were injected into TLR4 deficient (TLR4mut) mice or their wild-type (WT) littermates. T/HS, but not T/SS, lymph caused splenic apoptosis in the WT mice. However, the TLR4mutmice were resistant to T/HS lymph-induced splenic apoptosis. Furthermore, the WT, but not the TLR4mutmice developed splenic apoptosis after actual T/HS. In conclusion, gut-derived factors appear to initiate a sequence of events that leads to an acute increase in splenic and thymic immune cell apoptosis and this process is TLR4-dependent.