Esophageal cancer resection in the elderly

OBJECTIVE: Esophageal cancer is a disease whose prognosis is dismal andits surgery involves considerable risks, consequently the opportunity ofesophageal resection in elderly patients with esophageal cancer isquestionnable. The aim of this study was to analyze, with respect to theirage, the outcome of 386 consecutive patients who underwent esophagectomyand simultaneous replacement for cancer. METHODS: A chart review of allpatients with esophageal carcinoma admitted to our institution wasundertaken for the period January 1979-December 1994. RESULTS: The portionof patients of 70 years of age and older (14.5%) has slightly increasedduring the period. Location to the lower third of the esophagus andadenocarcinoma type were prevalent in the 56 elderly patients (group I),but their postsurgical TNM staging was identical to that of the 330 youngerpatients (group II). Other clinical features, i.e. preoperative weight lossand the presence of co- morbid diseases, however, were comparable in thetwo groups. Pulmonary function, as assessed by spirometry, wassignificantly worse among the older patients, but blood gas determinationswere not different. Operative mortality was comparable, between the twogroups (10.7% vs 11.2%). Major morbidity included anastomotic leak (10.7%vs 13.6%) and pulmonary complications (17.9% vs 20.6%) in both groups.Excellent palliation of dysphagia was achieved in 92% of the 50 group Ipatients who survived the operation. Long-term survival was not differentin elderly patients (5-year rate: 17%) when compared with that of youngerpatients (18.9%). CONCLUSION: These data suggest that esophagectomy can beperformed safely in selected septuagenarian patients, thus allowing asubstantial survival with excellent functional status in a portion of thesepatients.