ESOPHAGECTOMY FOR CARCINOMA OF THE ESOPHAGUS IN THE ELDERLY - RESULTSOF CURRENT SURGICAL-MANAGEMENT

Objective This study aims to evaluate the risk of esophagectomy in the elderly compared with younger patients and to determine whether resul ts of esophagectomy in the elderly have improved in recent years. Summ ary Background Data An increased life expectancy has led to more elder ly patients presenting with carcinoma of the esophagus in recent years . Esophagectomy for carcinoma of the esophagus is associated with sign ificant morbidity and mortality, and advanced age is often considered a relative contraindication to esophagectomy despite advances in modem surgical practice. Methods The perioperative outcome and long-term su rvival of 167 elderly patients (70 years or more) with esophagectomy f or carcinoma of the esophagus were compared with findings in 570 young er patients with esophagectomy in the period 1982 to 1996. Changes in perioperative outcome and survival between 1982 to 1989 and 1990 to 19 96 were separately analyzed. Results The resection rate in the elderly was 48% (167/345), lower than the 65% (570/874) resection rate in you nger patients (p < 0.001). There were significantly more preoperative risk factors and postoperative medical complications in the elderly, b ut no significant differences were observed in surgical complications. The 30-day mortality rate was higher in the elderly (7.2%) than in yo unger patients (3.0%) (p = 0.02), but the hospital mortality rate was not significantly different in the elderly (18.0%) and younger age gro ups (14.4%) (p = 0.27). The long-term survival after curative resectio n in elderly patients was worse than younger patients (p = 0.01). Howe ver, when deaths from unrelated medical conditions were excluded from analysis, survival was similar between the two age groups (p = 0.23). A comparison of data for the periods 1982 to 1989 and 1990 to 1996 rev ealed that the resection rate had increased from 44% to 54% in the eld erly, with significantly fewer postoperative complications and lower 3 0-day and hospital mortality rates. Long-term survival has also improv ed, although this has not reached a statistically significant level. C onclusions With current surgical management, esophagectomy for carcino ma of the esophagus can be carried out with acceptable risk in the eld erly, but intensive perioperative support is required. The improved re sults of esophagectomy in the elderly in recent years are attributed t o increased experience and better perioperative management. Long-term survival was similar to that of younger patients, excluding deaths cau sed by unrelated medical conditions.