Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

Abstract

Objective: Though the surgical treatment of esophageal cancer is increasingly accepted for elderly people defined as aged over 70 years, less is reported about the results in patients over 75. This study is a single institution retrospective analysis of outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Methods: All consecutive patients 76 years old and over undergoing curative esophagectomy for cancer in the period 1991-2006 were analyzed as to comorbidities, outcome and long-term survival. All the data had been prospectively collected in a database. Postoperative mortality risk was assessed by P-POSSUM and O-POSSUM score for in-hospital mortality and by the recently published Steyerberg's score system [Steyerberg EW, Neville BA, Koppert LB, Lemmens VEPP, Tilanus HW, Coebergh JWW, Weeks JC, Earle CC. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277-84.] for 30-day mortality. Five-year survival was compared to the standardized survival in the general population. Results: One hundred and eight patients fulfilling the abovementioned criteria were found (76 males and 32 females, mean age 79.5 years, mean standardized life-expectancy: 7.36 years). Among them, 69% had esophageal tumors and 31% GEJ tumors. The predominant histology was adenocarcinoma (74%). Eighty-six (79.6%) presented with one or more major comorbidities or a history of previous major upper-GI surgery, potentially affecting the surgical outcome. All underwent resection with curative intent (R 0 83.3%, R 1 12%, R 2 4.6%). The overall postoperative morbidity rate was 51.9%, pulmonary complications (37%) being the most frequent. Postoperative mortality, mainly due to cardiopulmonary complications, was 7.4%, which was consistent with that predicted by P-POSSUM score (7.2%) and lower than that predicted by O-POSSUM score (15.1%). Thirty-day mortality was 5.5%, being consistent with that predicted by the Steyerberg's score (6.8%). Overall 5-year survival was 35.7%, while R 0 overall survival 42% and cancer specific R 0 survival 51.7%. Conclusions: Patients 76 years old and over with esophageal or GEJ cancer should not be denied surgery solely on the basis of age. Outcome and long-term results in the selected elderly are not differing from those reported for younger patients. However, despite thorough preoperative assessment being applied in the selection of the candidates for surgery, a practical and reliable individual riskanalysis stratification is still lacking. #

Multicenter questionnaire survey on patterns of care for elderly patients with esophageal squamous cell carcinoma by the Japan Esophageal Oncology Group

“…Some reports still warn about the importance of careful selection of esophagectomy for elderly ESCC patients. It is repeatedly recommended that specialized evaluation of elderly patients should be performed, although there is a lack of validated or proposed criteria for esophagectomy (10)(11)(12)(13).…”

New serum biomarkers for detection of esophageal carcinoma using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

“…It is endemic in Asia, southern and eastern Africa, and northern France (Crew and Neugut 2004). Surgery is considered to be the best curative treatment for patients with esophageal cancer, however, the majority of patients present with an advanced stage of disease and long-term survival is poor (Besharat et al 2008;Alibakhshi et al 2009;Ruol et al 2007;Internullo et al 2008). In contrast, the 5-year survival for patients with stage I esophageal carcinoma exceeds 85% (Jacobs and Menon 2004;Menon and Jacobs 2000) Therefore, increasing the number of diagnosed with stage I disease should have a direct eVect on the mortality and economics of this cancer.…”

Esophagectomy in Elderly Patients With Esophageal Cancer

“…8,9 However, surgical treatment for esophageal cancer has been considered to be the most difficult among all kinds of gastrointestinal cancers, because of not only the biological aggressiveness of the cancer but also the anatomical characteristics. 3 Although the number of elderly patients with a diagnosis of potentially resectable esophageal cancer is increasing and the treatment quality is refined along with improvement of perioperative care, there is still contradictory data on the indication for surgery in such patients.…”