Surgical outcome of elderly patients 75 years of age and older with thoracic esophageal carcinoma.
BACKGROUND
This study aimed to evaluate the surgical outcome of esophagectomy in patients 75 years of age and older with thoracic esophageal carcinoma.


METHODS
Between 1980 and 2002, 55 (46%) of 120 patients 75 years of age and older with thoracic esophageal carcinoma underwent an esophagectomy. The risk factors that resulted in decreased survival were analyzed by both univariate and multivariate analyses. Differences in surgical outcome and long-term survival between the earlier time period (1980-1989) and later time period (1990-2002) were analyzed separately.


RESULTS
Overall resection rate in elderly patients in both periods was similar (44%, earlier period; 46%, later period). Postoperative complications significantly reduced long-term survival [adjusted hazard ratio for death, 4.05; 95% confidence interval (CI), 1.70-9.62; P < 0.01). Surgical blood loss greater than 1,000 ml was less frequently observed in the later period than in the earlier period (19% vs. 54%, P = 0.01). The postoperative morbidity rate was lower in the later than in the earlier period (29% vs. 63%, P = 0.02). Overall 5-year survival rate was significantly higher in the later period than in the earlier period (57% vs. 18%, P < 0.01).


CONCLUSIONS
Elderly patients who underwent an esophagectomy in the later period appeared to manifest less neoadjuvant treatment, less surgical stress, fewer postoperative complications, and a better long-term survival than those treated in the earlier period.
Shimada
Hideaki
H
Department of Frontier Surgery (M9), Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chiba, Japan. hshimada@faculty.chiba-u.jp
Shiratori
Tooru
T
Okazumi
Shinnichi
S
Matsubara
Hisahiro
H
Shuto
Kiyohiko
K
Akutsu
Yasunori
Y
Narushima
Kazuo
K
Nabeya
Yoshihiro
Y
Hayashi
Hideki
H
Ochiai
Takenori
T
D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome