Esophageal resection in elderly esophageal carcinoma patients: improvement in postoperative complications.
BACKGROUND
Advanced age is considered to be a relative contraindication for radical esophagectomy with a three-field lymph node dissection.


METHODS
Preoperative risks, postoperative morbidity and mortality, and long-term survival in 55 elderly patients (> or =70 years) who had undergone extensive esophagectomy for esophageal carcinoma were compared with those of 149 younger patients (<70 years).


RESULTS
Elderly patients had worse preoperative cardiopulmonary function and had more frequent postoperative cardiopulmonary complications compared with younger patients (p < 0.05). The postoperative death rate was not statistically different between the elderly (10.9%) and younger groups (5.4%). When the study period was divided into an early and a late phase, the postoperative death rate dropped significantly (p < 0.05) in recent years (1.4%) when compared with the previous era (10.0%). The overall survival rates were not different between elderly and younger patients.


CONCLUSIONS
Preoperative cardiopulmonary risk factors and postoperative complications after esophagectomy were more frequently noticed in elderly patients than in younger patients. A dramatic improvement in postoperative death was noticed in recent years. The long-term survival of elderly patients after extended esophagectomy was almost similar to that in younger patients.
Second Department of Surgery, Shimane Medical University, Japan. kinugasa@shimane-med.ac.jp
S
S
Kinugasa
M
M
Tachibana
H
H
Yoshimura
D K
DK
Dhar
M
M
Shibakita
S
S
Ohno
H
H
Kubota
R
R
Masunaga
N
N
Nagasue
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate