title: Is minimally invasive esophagectomy beneficial to elderly patients with esophageal cancer?
abstract: BACKGROUND
  Open esophagectomy (OE) in elderly patients with esophageal cancer is hazardous due to high surgical mortality and limited survival. The aim of this study was to explore whether minimally invasive esophagectomy (MIE) has perioperative or long-term benefits in elderly patients with esophageal cancer compared with OE.
  
  
  METHODS
  Between February 2005 and June 2013, 407 patients older than 70 years underwent esophagectomy for esophageal cancer, including 89 who received MIE and 318 who received OE. A retrospective pair-matched study was performed to compare 116 patients (58 pairs) who underwent either OE or MIE. Patients were matched by age, sex, comorbidity, tumor location, histology, TNM stage, and operative approach. Perioperative and long-term outcomes were compared between the two groups.
  
  
  RESULTS
  The overall incidence of postoperative complications was significantly lower in the MIE group than in the OE group (37.9 vs. 60.3 %, P = 0.016), especially incidence of pulmonary complications (20.7 vs. 39.7 %, P = 0.026). The mean length of hospital stay was also significantly shorter (10 days [range 7-70] vs. 12 days [range 8-106], P = 0.032). The perioperative mortality rate trended lower in the MIE group but was not significantly different (3.4 vs. 8.6 %, P = 0.435). Kaplan-Meier analysis showed that the median disease-specific survival time in the MIE group was significantly longer than in the OE group (>27 months [range 1-82] vs. 24 months [range 1-99], P = 0.003). No difference was found in overall survival (39 ± 8.9 vs. 22 ± 3.4 months, P = 0.070).
  
  
  CONCLUSIONS
  In surgical management of elderly patients with esophageal cancer, MIE is associated with lower rates of morbidity and pulmonary complications as well as longer disease-specific survival time. Whether it provides benefit to patients' long-term survival requires further research.
authors.affiliation: Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Jingpei
authors.initials: J
authors.lastname: Li
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Shen
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.forename: Mingxiang
authors.initials: M
authors.lastname: Feng
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Yong
authors.initials: Y
authors.lastname: Xi
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends