title: Surgery of gastric cancer and esophageal cancer: Does age matter?
abstract: BACKGROUND
  In the past, elderly patients with upper GI cancers were excluded from surgery or multimodal treatment only due to their advanced age. In an aging society this way of patient selection seems to be questionable. The aim of this retrospective exploratory study was to investigate how patients with upper GI cancer over the age of 70 years differ from younger patients in the postoperative course and which parameters influence overall survival in older patient populations.
  
  
  METHODS
  From 2002 to 2012 1,005 patients underwent resection of esophageal or gastric cancer at the University of Heidelberg. 272 patients were older than 70 years and analyzed in subgroups (70-74 years: n = 146; 75-79 years: n = 82; 80 years or older: n = 44). Patients older than 70 years were compared to patients under 70 years (n = 733) with focus on differences in patients characteristics and outcome. Statistical analyses were made retrospectively on a prospective database.
  
  
  RESULTS
  Fewer older patients were treated neoadjuvantly (< 70 years: 41.5%; > 70 years: 24.7%, P < 0.001) and extended resection (abdominothoracic approach) was applied less frequently compared to patients under 70 years (< 70 years: 38.9%; > 70 years: 19.9%, P < 0.001). The pNM-category (HR 1.41/2.56) and R-status (HR 1.78) remain the most important predictive factor for survival (all < 0.001). Female patients had a longer survival than men over the age of 70 (84.9 vs. 23.5 months, P < 0.01). Patients over 80 years had a significant shortened overall survival (> 80 years: 16.7 vs. < 70 years: 37.4 months) compared to the other subgroups (P < 0.001) and a significant increased in-hospital mortality (> 80 years: 20.5% vs. < 70 years: 6.0%, P = 0.002).
  
  
  CONCLUSIONS
  An exclusion from surgical therapy due to advanced age in general seems not to be justified. However, the decision for a surgical resection in patients over 80 years should be made with caution. pNM-categories and R0-resection remain the most important predictive factors for overall survival in all subgroups. No survival benefit for neoadjuvant treatment in patients over 70 years was found, while women survived longer than men. However, the decision concerning a (radio) chemotherapy should be made individually in each patient.
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Henrik
authors: H
authors: Nienhueser
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Romy
authors: R
authors: Kunzmann
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Leila
authors: L
authors: Sisic
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Susanne
authors: S
authors: Blank
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Moritz J
authors: MJ
authors: Strowitzk
authors: Institute of Medical Biometry and Infomatics IMBI, University of Heidelberg, Heidelberg, Germany.
authors: Thomas
authors: T
authors: Bruckner
authors: Department of Medical Oncology, National Center of Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
authors: Dirk
authors: D
authors: Jäger
authors: Department of Pathology, University of Heidelberg, Heidelberg, Germany.
authors: Wilko
authors: W
authors: Weichert
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Alexis
authors: A
authors: Ulrich
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Markus W
authors: MW
authors: Büchler
authors: Department of General, Vascular and Thoracic Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany.
authors: Katja
authors: K
authors: Ott
authors: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Thomas
authors: T
authors: Schmidt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000401:mortality*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
keywords: age; neoadjuvant treatment; upper GI cancer