The effect of age on the outcome of surgical treatment for carcinoma of the oesophagus and gastric cardia☆

Rahamim, J; Murphy, Gavin J.; Awan, Y; Junemann-Ramirez, M

doi:10.1016/s1010-7940(03)00034-4

Cited by 32 publications

(39 citation statements)

References 17 publications

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“…Still, a reliable individual risk analysis stratification to guide surgeons and oncologists in the decision making is missing: there is a significant lack in evidence regarding the treatment of cancer in the elderly population that is still under-enrolled in clinical trials [7]. The limit in the approach conducted so far is trying to apply to an older group the evidence that was provided by studies conducted on younger populations.…”

Section: Resultsmentioning

confidence: 99%

“…Some prospective [7,9] and retrospective [6][7][8] series focus on the recorded improvement over time in short-term outcome (i.e. morbidity and mortality) in aged patients undergoing esophagectomy, despite no significant increase in long-term survival.…”

Section: Discussionmentioning

confidence: 99%

“…This will require more prospective studies involving aged patients since only few have been published so far [7,9,23].…”

Section: Discussionmentioning

confidence: 99%

“…There is no established cut-off to define a patient as 'elderly' in relation to surgery, but most studies available so far set the age limit at 70 [5][6][7][8][9][10][11][12][13][14]: all these studies conclude that surgical resection is justified in selected aged patients, mainly those aged between 70 and 75 years. If esophagectomy for this group of patients is nowadays accepted, less is reported on patients over 75 [15][16][17].…”

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

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

Internullo

Moons

Nafteux

et al. 2008

European Journal of Cardio-Thoracic Surgery

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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. #

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…This will require more prospective studies involving aged patients since only few have been published so far [7,9,23].…”

Section: Discussionmentioning

confidence: 99%

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

See 2 more Smart Citations

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

Internullo

Moons

Nafteux

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…However, whether the prognosis of elderly patients after esophagectomy is more unfavorable than that in younger patients remains still controversial. Some reports emphasized the worse prognosis in elderly patients after esophagectomy [4,5] , whereas others emphasized similar outcome irrespective of the age [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

Zhu²,

Wang³

et al. 2006

WJG

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operation time, blood loss, and percentage of patients receiving blood transfusion of the elderly patients significantly improved from the former period to the recent period. The hospital mortality rate of the elderly patients dropped from the former period (5.9%) to the recent period (2.3%), but it was not statistically significant. CONCLUSION:Preoperative medical risk factors and postoperative cardiopulmonary complications after esophagectomy are more common in the elderly, but operative mortality is comparable to that of younger patients. These encouraging results and improvements in postoperative mortality and morbidity of the elderly patients in recent period are attributed to better surgical techniques and more intensive perioperative care in the elderly.

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Oesophagectomy practice and outcomes in England

Al-Sarira

David

Willmott

et al. 2007

British Journal of Surgery

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The effect of age on the outcome of surgical treatment for carcinoma of the oesophagus and gastric cardia☆

Cited by 32 publications

References 17 publications

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

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

Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

Oesophagectomy practice and outcomes in England

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