title: Short and long-term outcomes after esophagectomy for cancer in elderly patients.
abstract: BACKGROUND
  As worldwide life expectancy rises, the number of candidates for surgical treatment of esophageal cancer over 70 years will increase. This study aims to examine outcomes after esophagectomy in elderly patients.
  
  
  METHODS
  This study is a retrospective review of 474 patients undergoing esophagectomy for cancer during 2002 to 2011. A total of 334 (70.5%) patients were less than 70 years old (group A), 124 (26.2%) 70 to 79 years (group B), and 16 (3.4%) 80 years or greater (group C). We analyzed the effect of age on outcome variables including overall and disease specific survival.
  
  
  RESULTS
  Major morbidity was observed to occur in 115 (35.6%) patients of group A, 58 (47.9%) of group B, and 10 (62.5%) of group C (p = 0.010). Mortality, both 30-day and 90-day was observed in 2 (0.6%) and 7 (2.2%) of group A, 4 (3.2%) and 7 (6.1%) of group B, and 1 (6.3%) and 2 (14.3%) of group C, respectively (p = 0.032 and p = 0.013). Anastomotic leak was observed in 16 (4.8%) patients of group A, 6 (4.8%) of group B, and 0 (0%) of group C (p = 0.685). Anastomotic stricture (defined by the need for ≥ 2 dilations) was observed in 76 (22.8%) of group A, 13 (10.5%) of group B, and 1 (6.3%) of group C (p = 0.005). Five-year overall and disease specific survival was 64.8% and 72.4% for group A, 41.7% and 53.4% for group B, 49.2% and 49.2% for group C patients (p = 0.0006), respectively.
  
  
  CONCLUSIONS
  Esophagectomy should be carefully considered in patients 70 to 79 years old and can be justified with low mortality. Outcomes in octogenarians are worse suggesting esophagectomy be considered on a case by case basis. Stricture rate is inversely associated to age.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Tapias
authors.forename: Ashok
authors.initials: A
authors.lastname: Muniappan
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Morse
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology