ESOPHAGEAL CANCER RESECTION IN THE ELDERLY

Objective, Esophageal cancer is a disease whose prognosis is dismal an d its surgery involves considerable risks, consequently the opportunit y of esophageal resection in elderly patients with esophageal cancer i s questionnable. The aim of this study was to analyze, with respect to their age, the outcome of 386 consecutive patients who underwent esop hagectomy and simultaneous replacement for cancer. Methods. A chart re view of all patients with esophageal carcinoma admitted to our institu tion was undertaken for the period January 1979-December 1994. Results . The portion of patients of 70 years of age and older (14.5%) has sli ghtly increased during the period. Location to the lower third of the esophagus and adenocarcinoma type were prevalent in the 56 elderly pat ients (group I), but their postsurgical TNM staging was identical to t hat of the 330 younger patients (group II). Other clinical features, i .e. preoperative weight loss and the presence of co-morbid diseases, h owever, were comparable in the two groups. Pulmonary function, as asse ssed by spirometry, was significantly worse among the older patients, but blood gas determinations were not different. Operative mortality w as comparable, between the two groups (10.7% vs 11.2%). Major morbidit y included anastomotic leak (10.7% vs 13.6%) and pulmonary complicatio ns (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 operat ion. Long-term survival was not different in elderly patients (5-year rate: 17%) when compared with that of younger patients (18.9%). Conclu sion. These data suggest that esophagectomy can be performed safely in selected septuagenarian patients, thus allowing a substantial surviva l with excellent functional status in a portion of these patients.