title: Surgical outcome of elderly patients 75 years of age and older with thoracic esophageal carcinoma.
abstract: 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.
authors.affiliation: Department of Frontier Surgery (M9), Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chiba, Japan. hshimada@faculty.chiba-u.jp
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Tooru
authors.initials: T
authors.lastname: Shiratori
authors.forename: Shinnichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Kazuo
authors.initials: K
authors.lastname: Narushima
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: 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