title: Esophagectomy in patients aged over 80 years with esophageal cancer.
abstract: OBJECTIVE
  Esophagectomy for esophageal cancer is one of the most invasive surgical procedures. However, with the recent aging of the population, clinicians are increasingly encountering patients with advanced age (over 80 years) who require treatment for esophageal cancer. Patients in this age group tend to be regarded as at high risk in terms of surgical treatment. In the present study, the authors examined perioperative complications and clinical outcome in esophagectomy in patients aged over 80 years compared with those aged 70-79 and discuss the risk and appropriateness of esophagectomy in the older group.
  
  
  METHODS
  Of patients with esophageal cancer at our institute, 25 were aged over 80 years, while 95 were aged 70-79 years. We statistically compared those who underwent esophagectomy; 8 in the older group and 62 in the younger group. The oldest patient was an 84-year-old man. Among the 8 older patients, 7 were male and 1 was female. All cases were histologically confirmed as squamous cell carcinoma and this series included 1 case in Stage 0, 3 in Stage I and 4 in Stage III. Total thoracic esophagectomy was performed in 5 patients, transhiatal blunt dissection in 2 and lower thoracic esophagectomy in 1.
  
  
  RESULTS
  Rate of surgical treatment was significantly lower in the older group than in the younger group (32.0% vs. 65.3%, p < 0.001). No significant difference was observed in postoperative complications or mortality. Regarding clinical postoperative outcome in the older group, there were 5 deaths: 1 related to surgery, 2 to other causes (at 5 and 12 months), 2 to cancer (4 and 11 months). The remaining patients were alive at 31, 60, and 88 months. No significant difference was observed in overall or disease specific survival after surgery between the 2 groups.
  
  
  CONCLUSIONS
  No statistically significant differences were apparent in morbidity, mortality or clinical outcome in the 2 groups. Since surgery seems to confer similar symptomatic improvements and survival in patients aged over 80 to those expected for patients aged 70-79, we believe that surgeons should not withhold esophagectomy in patients aged over 80 years because of advanced age alone.
authors.affiliation: Department of Oncological Science (Surgery II), Oita University Faculty of Medicine, Oita, Japan. takeno@med.oita-u.ac.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takeno
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ono
authors.forename: Mirei
authors.initials: M
authors.lastname: Kamei
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Kawahara
mesh_terms: D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate