Age Should not Limit Consideration of Aggressive Surgical Procedures in Elderly
Treatment for cancer of the esophagus, the tube that connects the throat to the stomach, usually includes surgery or radiation therapy, sometimes with chemotherapy. Surgery often involves an esophagectomy, or removal of part or all of the esophagus, to help relieve the symptoms of disease, prevent the cancer from recurring (returning), and prolong survival time. Because an esophagectomy and other aggressive surgical procedures can be associated with major complications, many doctors believe that elderly persons cannot tolerate such a procedure and therefore do not recommend this option. Researchers at the Beth Israel Deaconess Medical Center disagree. Indeed, they recently reported that advanced age should not be a limiting factor in using aggressive surgical methods for the treatment of esophageal cancer.
The researchers at Beth Israel Deaconess have long advocated an aggressive surgical approach to treating esophageal cancer, regardless of a patient’s age. They treated 505 persons with esophageal cancer between 1970 and 1997; 147 of these individuals were 70 years of age or older. The locations of cancer and types of cancer were similar between the older and younger groups, except that more younger persons had a condition called Barrett’s esophagus. The types of surgical procedures performed and the proportion of patients who were able to have complete removal of detectable cancer via the surgery were also similar between the 2 age groups. The outcome showed that the ability to achieve a satisfactory reduction in swallowing difficulties was similar between the 2 age groups. There was a slightly higher incidence of deaths while in the hospital among the elderly patients; however, this difference was not statistically significant. The 5-year survival rate was 24% in the elderly group, 22% in the younger group.
These findings suggest that the age of a patient should not be considered a limiting factor when considering the use of aggressive surgical intervention as a treatment option for persons with esophageal cancer. Older persons who have cancer of the esophagus may wish to talk with their doctor about the risks and benefits of surgery and other treatment options. (Journal of the American College of Surgery, Vol 187, No 4, pp 345-351, 1998)