title: Preoperative chemoradiotherapy prior to esophagectomy in elderly patients is not associated with increased morbidity.
abstract: BACKGROUND
  Preoperative chemotherapy and radiation therapy are often administered to patients with esophageal cancer. Despite an aging population, little data exist regarding feasibility of preoperative therapy in elderly patients.
  
  
  METHODS
  Between January 1997 and December 2002, 312 consecutive patients underwent esophagectomy for esophageal cancer at our institution. Outcomes of patients 70 years old, who underwent preoperative therapy (n = 35; group II), were compared with those of patients who did not (n = 39; group I) and with those of patients younger than 70 years old who received preoperative therapy (n = 165; group III).
  
  
  RESULTS
  The median age was 75 years old for group I and 72 years for group II (p < 0.001). The patients in group II were of more advanced clinical stage (p < 0.001). There were no differences in performance status, comorbidities, or preoperative symptoms between the two groups. Similar proportions of patients in the groups I and II underwent a transhiatal approach (52.5% vs 42.8%, p = not significant [NS]). Perioperative mortality for groups I and II was 0% and 3%, respectively (p = NS). Group II received more perioperative blood transfusions (71.4% vs 48.7%, p = 0.047). There were no differences in the rates of postoperative cardiac, pulmonary, neurologic, gastrointestinal, or anastomotic complications. Compared with group III, group II patients had higher rates of postoperative atrial arrhythmias (p = 0.013) and perioperative blood transfusions (p = 0.004).
  
  
  CONCLUSIONS
  Elderly patients receiving preoperative therapy for esophageal cancer do not have an increased incidence of major postoperative complications. Elderly patients receiving preoperative therapy are more likely to develop postoperative atrial arrhythmias and require transfusion than younger patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. drice@mdanderson.org
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sodhi
authors.forename: W Roy
authors.initials: WR
authors.lastname: Smythe
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001363:Awards and Prizes; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery; D002318:Cardiovascular Diseases / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy / Q000145:classification / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011292:Premedication; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate