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Clinical effects of esophagectomy for patients 80 years of age and older with thoracic esophageal cancer

Morita, M.; Nishida, K.; Koga, T.; Egashira, A.; Tokunaga, E.; Oki, E.; Sadanaga, N.; Kakeji, Y.; Maehara, Y.

Journal of Clinical Oncology 24(18_Suppl): 4049-4049

2016


ISSN/ISBN: 0732-183X
PMID: 27953681
Accession: 057421626

NlmCategory="UNASSIGNED">4049 Background: Esophageal cancer tends to mainly occur in elderly patients. Although a radical operation is the most effective existing therapy, the associated operative morbidity is still high. As a result, the indications for an esophagectomy in elderly patients (especially for patients over 80 years of age) remain controversial. A total of 599 patients with thoracic esophageal cancer who underwent an esophagectomy by the transthoracic approach since 1986 were evaluated. They were divided into 3 groups depending on age, namely groups I (<69 y.o., n = 441), II (70-79 y.o., n = 143) and III (≥80 y.o., n = 15). No significant differences were observed in the location of the tumor, histological type or stage. A distal esophagectomy with a left thoracotomy was performed for 40, 46, and 47% of the patients, respectively, while the others underwent a subtotal esophagectomy with a right thoracotomy. In group III, surgery was only done for cases with PS 0 or 1 as well as a normal cardiac and pulmonary function (ejection fraction ≥65 %, vital capacity ≥80 %, FEV 1.0% > 70%). Postoperative complications occurred in 31 % of group I and 39 % of group II patients, and the incidence of pulmonary complication was 9 and 18 %, respectively (P < 0.01). In group III, the operative morbidity and mortality were 27 and 0 %, respectively, and pulmonary complications only occurred in one patient (7%). No significant difference was observed in the disease-free survival (DFS: 50, 46 and 58 % for 3yrs, 44, 40 and 33 % for 5 yrs), while the overall survival rates were worse in the older groups as a result of death due to causes other than recurrence (45, 34 and 34 % for 3yrs and 38, 26 and 9 % for 5 yrs in groups I, II and III, respectively. P < 0.01 group I v.s. II). An esophagectomy is considered to be a viable treatment alternative in patients over 80 years of age without increasing morbidity, when the indications for surgery are strictly determined. Furthermore, the DFS in these patients was similar to that observed in younger patients although the incidence of death due to causes other than cancer was found to be higher. An esophagectomy should therefore be considered as an effective treatment strategy even in elderly patients over 80 years of age. No significant financial relationships to disclose.

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