Extended esophagectomy in elderly patients with esophageal cancer: minor effect of age alone in determining the postoperative course and survival

Abstract

Background: Elderly patients who undergo esophagectomy for cancer often have a high prevalence of coexisting diseases, which may adversely affect their postoperative course. We determined the relationship of advanced age (i.e., > or =70 years) with outcome and evaluated age as a selection criterion for surgery.

Methods: Between January 1991 and January 2007, we performed a curative-intent extended transthoracic esophagectomy in 234 patients with cancer of the esophagus. Patients were divided into two age groups: <70 years (group I; 170 patients) and > or =70 years (group II; 64 patients).

Results: Both groups were comparable regarding comorbidity (American Society of Anesthesiologists classification), and tumor and surgical characteristics. The overall in-hospital mortality rate was 6.2% (group I, 5%, vs. group II, 11%, P = 0.09). Advanced age was not a prognostic factor for developing postoperative complications (odds ratio, 1.578; 95% confidence interval, 0.857-2.904; P = 0.143). The overall number of complications was equal with 58% in group I vs. 69% in group II (P = 0.142). Moreover, the occurrence of complications in elderly patients did not influence survival (P = 0.174). Recurrences developed more in patients <70 years (58% vs. 42%, P = 0.028). The overall 5-year survival was 35%, and, when included, postoperative mortality was 33% in both groups (P = 0.676).The presence of comorbidity was an independent prognostic factor for survival (P = 0.002).

Conclusions: Advanced age (> or =70 years) has minor influence on postoperative course, recurrent disease, and survival in patients who underwent an extended esophagectomy. Age alone is not a prognostic indicator for survival. We propose that a radical resection should not be withheld in elderly patients with limited frailty and comorbidity.

Fig. 1

Kaplan–Meier overall survival curve (n = 234) of patients in group I (age < 70 years) and group II (age ≥ 70 years) (n = 170 vs. n = 64, P = 0.535), including postoperative mortality

Fig. 2

a Kaplan–Meier survival curve of patients in group I (age < 70 years) with preoperative comorbidity and those without (n = 65 vs. n = 105, P = 0.472). b Kaplan–Meier survival curve of patients in group II (age ≥ 70 years) with preoperative comorbidity and those without (n = 32 vs. n = 32, P = 0.087)

Fig. 3

Kaplan–Meier survival curve of patients with preoperative comorbidity and those without, regardless of age (n = 97 vs. n = 137, P = 0.001)