Esophagectomy in Elderly Patients Results in Similar Outcomes as for Younger Patients
Increasing life expectancy is associated with an increasing number of elderly patients with esophageal cancer. Under the best of circumstances esophagectomy is associated with a high operative death rate and high frequency of major complications. Advanced age is thought to be a contraindication for esophagectomy by many physicians.
Physicians in Hong Kong evaluated the results of esophagectomy in 167 patients age 70 years or greater. Results were compared to those of 570 younger patients. The resection rate was 48% for elderly patients and 65% for younger patients. Most of the younger patients had esophagectomy by a trans-thoracic approach and most of the older patients by a trans-hiatal approach.
Importantly, there were no differences in the number of surgical complications between the elderly and young patients. Seven per cent of elderly patients died in the first 30 days after surgery compared to 3% of younger patients. The overall death rate in the hospital was 18% for elderly patients and 14% for younger patients. Long-term survival was worse in elderly patients but this was due to causes other than esophageal cancer. There was evidence that survival was improving with increased experience in treating elderly patients.
These physicians concluded that esophagectomy for cancer of the esophagus could be carried out in the elderly but that intensive supportive care was required. Long-term survival was similar to that of younger patients when death from unrelated medical conditions were excluded. Age alone is not a contraindication for esophagectomy in elderly patients. Patients should seek care at institutions that have significant experience in performing esophagectomy. (
Annals of Surgery, Vol 227, No 3, pp 357-364, 1998)