ESOPHAGECTOMY FOR CARCINOMA IN THE OCTOGENARIAN

Background. Esophageal carcinoma is predominantly a disease of the eld erly, a group often only considered for palliative therapies. Methods. A case note review identified 31 octogenarians undergoing resection f or carcinoma of the esophagus or gastric cardia over a 12-year period ending December 1994. Results. Nineteen patients made either an uncomp licated postoperative recovery (n = 12) or suffered minor complication s (n = 7). Of the 12 patients who suffered moderate or severe complica tions, 5 died (in-hospital mortality, 16%). The deaths included 2 of 3 patients who underwent emergency operation for esophageal perforation and 3 of 28 patients who underwent elective esophagectomy (elective m ortality rate, 10.7%). Nineteen of the 26 survivors (73%) experienced no further dysphagia. The 5-year survival rate was 17%. Conclusions. E lective esophageal resection can be performed safely in selected octog enarians who have no or few coexisting medical problems and present wi th a localized carcinoma that is technically easy to resect. Patients undergoing emergency operations or in whom moderate or severe postoper ative complications develop often have poor physiologic reserve and ar e therefore at risk of early postoperative death.