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. 2024 Jul 22;13(14):4271.
doi: 10.3390/jcm13144271.

Short- and Long-Term Outcomes in Elderly Patients with Resectable Esophageal Cancer: Upfront Esophagectomy Compared to Surgery after Neoadjuvant Treatments

Lucia Moletta  1 , Elisa Sefora Pierobon  1 , Giovanni Capovilla  1 , Irene Sole Zuin  1 , Jose Luis Carrillo Lizarazo  1 , Giulia Nezi  1 , Sara Lonardi  2 , Sabina Murgioni  2 , Sara Galuppo  3 , Gianpietro Zanchettin  1 , Renato Salvador  1 , Luca Provenzano  1 , Michele Valmasoni  1
Affiliations

Short- and Long-Term Outcomes in Elderly Patients with Resectable Esophageal Cancer: Upfront Esophagectomy Compared to Surgery after Neoadjuvant Treatments

Lucia Moletta et al. J Clin Med. .

Abstract

Background/Objectives: Despite the increased incidence of esophageal cancer (EC) in elderly people, there are no clear guidelines for its treatment in these patients. The aim of this study was to compare the outcomes of patients ≥ 75 years with resectable EC, receiving either upfront esophagectomy or neoadjuvant treatment. Methods: We retrospectively identified 127 patients with resectable EC ≥ 75 years who underwent esophagectomy between January 2000 and December 2022 at our Clinic in the University Hospital of Padova. The included patients were stratified into two groups: patients undergoing upfront esophagectomy (SURG group) and patients receiving neoadjuvant treatment (NAT group). Results: There were no statistically significant differences in OS (p = 0.7708), DFS (p = 0.7827) and cancer-related survival (p = 0.0827) between the SURG and the NAT group, except for the OS of EAC with stage III-IV, where the NAT group experienced a significant benefit in OS (p = 0.0263). When comparing the two groups, patients receiving neoadjuvant treatment experienced a significantly higher rate of postoperative complications (p = 0.0266). At univariate analysis, neoadjuvant therapy was the only variable strongly associated with postoperative morbidity (p = 0.026). Conclusions: Considering the unique characteristics of elderly patients, the choice of a multimodal approach should be tailored to each case in a multidisciplinary setting and balanced with a potential higher risk of postoperative complications, as well as potential toxicity related to chemoradiation and reduced life expectancy.

Keywords: elderly; esophageal cancer; frailty; multimodal treatment; upfront esophagectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Overall survival for the entire cohort of patients; (b) cancer-related survival for the entire cohort of patients.
Figure 2
Figure 2
Disease-free survival for the entire cohort of patients.
Figure 3
Figure 3
Overall survival according to histology. (a) EAC, (b) SCC.
Figure 4
Figure 4
Overall survival according to histology and stage. (a) OS for EAC stages 3–4; (b) OS according to SCC stages 3–4.
See this image and copyright information in PMC

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