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Esophagectomy for cancer in octogenarians: should we do it?

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Abstract

Purpose

Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer.

Methods

A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years. A case-matched group of patients younger than 80 years old (n = 33) was included based on the Charlson comorbidity index with the octogenarian group (n = 33). Endpoints included operative morbidity and mortality as well as short- and long-term survival.

Results

Thirty-three octogenarians met inclusion criteria. The median age was 82 years, and 79% were male; 76% had adenocarcinoma, 87% had distal esophageal, and 52% had poorly differentiated tumors. Stages 0 through III were observed in 6, 18, 27, and 48% of octogenarians, respectively. Neoadjuvant therapy was administered to 70% of patients, with 48% experiencing downstaging. Transhiatal esophagectomy was performed in 82% of patients, with R0 resection in 94%. The mean hospital stay was 18 days, with morbidity and mortality rates 56 and 9%, respectively, not significantly different from 13-day hospital stay, 45% morbidity, and 9% mortality in younger patients. Cardiac, pulmonary, and surgical site complications occurred in 24, 27, and 6% of octogenarians, respectively. Anastomotic leak occurred in 18% and reoperations in 3%. The median, 3-year survival, and 5-year survival were 21 months, 55.9%, and 37.1%, respectively. Overall survival was worse for octogenarians (p < 0.001).

Conclusions

Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

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References

  1. Markar SR, Karthikesalingam A, Thrumurthy S, Ho A, Muallem G, Low DE (2013) Systematic review and pooled analysis assessing the association between elderly age and outcome following surgical resection of esophageal malignancy. Diseases of the Esophagus 26(3):250–262

    Article  CAS  PubMed  Google Scholar 

  2. SEER (2014) Cancer statistics factsheets: esophageal cancer [database on the Internet]. Available from: http://seer.cancer.gov/statfacts/html/esoph.html

  3. Chang AC, Lee JS (2009) Resection for esophageal cancer in the elderly. Thorac Surg Clin 19(3):333–343

    Article  PubMed  Google Scholar 

  4. Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734

    Article  PubMed  Google Scholar 

  5. Matsumoto S, Takayama T, Wakatsuki K et al (2013) Predicting early cancer-related deaths after curative esophagectomy for esophageal cancer. Am Surg 79(5):528–533

    PubMed  Google Scholar 

  6. McLoughlin JM, Lewis JM, Meredith KL (2013) The impact of age on morbidity and mortality following esophagectomy for esophageal cancer. Cancer Control 20(2):144–150

    PubMed  Google Scholar 

  7. Schweigert M, Solymosi N, Dubecz A, Stadlhuber RJ, Ofner D, Stein HJ (2013) Current outcome of esophagectomy in the very elderly: experience of a German high-volume center. Am Surg 79(8):754–763

    PubMed  Google Scholar 

  8. Morita M, Otsu H, Kawano H et al (2013) Advances in esophageal surgery in elderly patients with thoracic esophageal cancer. Anticancer Res 33(4):1641–1647

    PubMed  Google Scholar 

  9. Salive ME (2013) Multimorbidity in older adults. Epidemiol Rev

  10. Zhang Y (2013) Epidemiology of esophageal cancer. World J Gastroenterol: WJG 19(34):5598–5606

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zehetner J, Lipham JC, Ayazi S et al (2010) Esophagectomy for cancer in octogenarians. Diseases of the Esophagus 23(8):666–669

    Article  CAS  PubMed  Google Scholar 

  12. Furlong H, Bass G, Breathnach O, O’Neill B, Leen E, Walsh TN (2013) Targeting therapy for esophageal cancer in patients aged 70 and over. Journal of Geriatric Oncology 4(2):107–113

    Article  PubMed  Google Scholar 

  13. Poon RT, Law SY, Chu KM, Branicki FJ, Wong J (1998) Esophagectomy for carcinoma of the esophagus in the elderly: results of current surgical management. Ann Surg 227(3):357–364

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Internullo E, Moons J, Nafteux P et al (2008) Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg 33:1096–1104

    Article  PubMed  Google Scholar 

  15. Charlson ME, Pompei P, Ales K, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  16. Extermann M (2000) Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol 35(3):181–200

    Article  CAS  PubMed  Google Scholar 

  17. Hall WH, Ramachchandran R, Narayan S, Jani AB, Vijaryakumar S (2003) An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 4:94

    Article  Google Scholar 

  18. Viklund P, Lindblad M, Lu M, Ye W, Johansson J, Lagergren J (2006) Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg 243(2):204–211

    Article  PubMed  PubMed Central  Google Scholar 

  19. Atkins BZ, Shah AS, Hutcheson KA et al (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78(4):1170–1176

    Article  PubMed  Google Scholar 

  20. Ferri LE, Law S, Wong KH, Kwow KF, Wong J (2006) The influence of technical complications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol 13(4):557–564

    Article  PubMed  Google Scholar 

  21. Aust JB, Henderson W, Khuri S, Page CP (2005) The impact of operative complexity on patient risk factors. Ann Surg 241(6):1024–1027

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shende MR, Waxman J, Luketich JD (2007) Predictive ability of preoperative indices for esophagectomy. Thorac Surg Clin 17(3):337–341

    Article  PubMed  Google Scholar 

  23. Lagarde SM, Reitsma JB, Maris A-KD et al (2008) Preoperative prediction of the occurrence and severity of complications after esophagectomy for cancer with use of a nomogram. Ann Thorac Surg 85(6):1938–1194

    Article  PubMed  Google Scholar 

  24. Nienhueser H, Kunzmann R, Sisic L et al (2015) Surgery of gastric cancer and esophageal cancer: does age matter? J Surg Onc 112:387–395

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Miami-Miller School of Medicine, 1120 NW 14th Street, CRB (C232), Miami, FL, 33136, USA

    Elizabeth Paulus, Caroline Ripat, Vadim Koshenkov, Angela T. Prescott, Kiran Sethi, Heather Stuart, Gregory Tiesi, Alan S. Livingstone & Danny Yakoub

Authors
  1. Elizabeth Paulus
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  2. Caroline Ripat
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  3. Vadim Koshenkov
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  4. Angela T. Prescott
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  5. Kiran Sethi
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  6. Heather Stuart
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  7. Gregory Tiesi
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  8. Alan S. Livingstone
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  9. Danny Yakoub
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Contributions

Author’s contributions

YD was responsible for the study conception and design. KV, PA, SK, and PE performed the acquisition of the data. RC did the analysis of the data. PE, RC, and YD prepared the manuscript. TG, SH, LA, and YD reviewed the manuscript. YD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Danny Yakoub.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclosures

There was no external funding for this work.

Financial and proprietary information

The authors do not have any proprietary potential in this study.

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Paulus, E., Ripat, C., Koshenkov, V. et al. Esophagectomy for cancer in octogenarians: should we do it?. Langenbecks Arch Surg 402, 539–545 (2017). https://doi.org/10.1007/s00423-017-1573-x

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  • DOI: https://doi.org/10.1007/s00423-017-1573-x

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