title: Clinical Outcome of Esophagectomy in Elderly Patients With and Without Neoadjuvant Therapy for Thoracic Esophageal Cancer.
abstract: BACKGROUND
  Esophageal cancer occurs predominantly in elderly people. To date, there is no standardized treatment protocol for elderly patients with esophageal cancer. The aim of the present study was to assess the effect of old age (≥ 80 years) on treatment and outcome of esophageal cancer.
  
  
  METHODS
  We divided 722 patients who underwent esophagectomy between January 2000 and December 2012 into 4 age groups (<70, ≥ 70 to <75, ≥ 75 to <80, and ≥ 80 years) and analyzed the differences among the groups in treatment strategy (preoperative treatment and surgery) and short- and long-term outcome after esophagectomy.
  
  
  RESULTS
  Preoperative chemotherapy was significantly less frequently used for the octogenarians than the other groups. Three-field lymphadenectomy was less frequently used with increasing age. Advanced age tended to be associated with higher frequency of postoperative pulmonary and cardiovascular complications, but not with change in mortality rate, compared with younger patients. The overall survival rate was significantly lower in patients of the group ≥ 75 to <80 and group ≥ 80, compared with group<70 (p = 0.011, p = 0.002). Advanced age, low body mass index, postoperative complications, and pathological stage were independent and significant prognostic factors in elderly patients who underwent esophagectomy.
  
  
  CONCLUSIONS
  Elderly patients aged 75 years and more, especially octogenarians, showed relatively poor prognosis compared with younger patients partly because they less often received neoadjuvant therapy. Aggressive treatment may be recommended for elderly patients after taking into careful consideration the overall physical condition.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. hmiyata@gesurg.med.osaka-u.ac.jp.|Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. hmiyata@gesurg.med.osaka-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Makino
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery