European Journal of Cardio-Thoracic Surgery, Vol 10, 941-946, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Esophageal cancer resection in the elderly
P Thomas, C Doddoli, P Neville, J Pons, P Lienne, R Giudicelli, M Giovannini, JF Seitz and P Fuentes
Department of Thoracic Surgery, Sainte Marguerite University Hospital, Marseille, France.
OBJECTIVE: Esophageal cancer is a disease whose prognosis is dismal and its
surgery involves considerable risks, consequently the opportunity of
esophageal resection in elderly patients with esophageal cancer is
questionnable. The aim of this study was to analyze, with respect to their
age, the outcome of 386 consecutive patients who underwent esophagectomy
and simultaneous replacement for cancer. METHODS: A chart review of all
patients with esophageal carcinoma admitted to our institution was
undertaken for the period January 1979-December 1994. RESULTS: The portion
of patients of 70 years of age and older (14.5%) has slightly increased
during the period. Location to the lower third of the esophagus and
adenocarcinoma type were prevalent in the 56 elderly patients (group I),
but their postsurgical TNM staging was identical to that of the 330 younger
patients (group II). Other clinical features, i.e. preoperative weight loss
and the presence of co- morbid diseases, however, were comparable in the
two groups. Pulmonary function, as assessed by spirometry, was
significantly worse among the older patients, but blood gas determinations
were not different. Operative mortality was comparable, between the two
groups (10.7% vs 11.2%). Major morbidity included anastomotic leak (10.7%
vs 13.6%) and pulmonary complications (17.9% vs 20.6%) in both groups.
Excellent palliation of dysphagia was achieved in 92% of the 50 group I
patients who survived the operation. Long-term survival was not different
in elderly patients (5-year rate: 17%) when compared with that of younger
patients (18.9%). CONCLUSION: These data suggest that esophagectomy can be
performed safely in selected septuagenarian patients, thus allowing a
substantial survival with excellent functional status in a portion of these
patients.
