Esophagectomy in the Late Nineties

Bowrey, David J.; Johansson, Jan L. M.; Johnson, David
August 1999
American Journal of Gastroenterology;Aug1999, Vol. 94 Issue 8, p2309
Academic Journal
These two papers, published in the same month, have addressed a controversial issue--the role of esophagectomy in the elderly patient. Both studies compared the outcome after esophagectomy of elderly patients with that of their younger counterparts. The first paper from Boston comprised patients with carcinoma of the esophagus or cardia treated by one surgical team during the years 1970-1997, Patients were divided according to age into two groups: those aged ≥70 yr (n = 147) and those aged <70 (n = 358). The two groups were well matched for cancer stage and tumor location. Further, the percentage of patients undergoing resection (90% both groups), the surgical procedures performed, and the percent-age of RO resections performed were comparable between the two groups. There were no differences in either the complication rate (28% vs 31%) or the types of complications arising, between the two groups. Similarly, the 30-day mortality (4.5% vs 1.25%) and the in-hospital mortality (5.3% vs 2.4%) were not significantly different between the groups. At long-term follow-up, survival for elderly patients (median 1.6 yr) was equivalent to that for younger patients (median 1.5 yr). After adjustment for in-hospital and noncancer deaths, the 5-yr actuarial survival rates were 27% for elderly patients and 24% for younger patients. The second paper from Nottingham, England, reported on 686 patients with carcinoma of the esophagus or gastro-esophageal junction treated between 1987 and 1997. Patients were divided into three groups by age: <70 yr, 70-79 yr, and ≥80 yr. Thirty-one patients were excluded from surgery on medical grounds. A higher proportion of octogenarians (20%) fell within this category compared to the other groups (<70 yr, 2%; 70-79 yr, 5%). Of the 655 patients undergoing surgery, 523 underwent resection (80%). Among the resected patients, there were no significant differences in tumor histology, tumor location, surgical approach, or disease stage between the three age groups. Postoperative complications occurred significantly more frequently in the older groups of patients (70-79 yr, 34%; ≥80 yr, 36%) compared to younger patients (25%). However, this did not translate into an increased in-hospital mortality (5-6% in each group). There were no significant differences in the median survival between the patients <70 yr (1.6 yr), patients aged 70-79 yr (1.7 yr) and those ≥80 yr (1,7 yr). Actuarial 5-yr survivals for the three groups were 25%, 21%, and 20%, respectively.


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