CANCER OF THE ESOPHAGUS AND CARDIA - DOES AGE INFLUENCE TREATMENT SELECTION AND SURGICAL OUTCOMES

Background: Some physicians believe that an aggressive surgical approa ch for the management of cancer of the esophagus and cardia is unwise in elderly patients because of allegedly higher rates of mortality and morbidity and lower rates of survival than those associated with youn ger patients. We have long advocated an aggressive surgical approach r egardless of the patient's age and have reviewed our experience to det ermine whether age was a factor influencing treatment and outcomes. St udy Design: From January 1, 1970 to January 1, 1997, 505 patients with cancer of the esophagus or cardia underwent operations by one surgica l team using standard surgical techniques. One hundred forty-seven pat ients (29.1%) were 70 years of age or older and 358 patients (70.9%) w ere under 70 years of age. Their records and clinicopathologic feature s were reviewed and compared. Results: The two groups were similar reg arding the location of tumors. Tumor cell types were similar except fo r adenocarcinomas in Barrett's esophagus, which were less common in th e older group (15.6% versus 24%; p = 0.046). Surgical procedures were similar, as were the rates of resectability and the percentages of RO resections. The hospital mortality rate was higher in the elderly pati ents but not significantly so, and the rates of major and minor compli cations combined were comparable. The differences in postresection pat hologic staging were not significant. Satisfactory palliation of dysph agia was comparable between the groups, as were actuarial 5-year survi val rates (24.1% of the elderly patients versus 22.4% of the younger p atients). Conclusions: Age should not be a limiting factor in using an aggressive surgical approach for the management of cancer of the esop hagus or cardia in patients aged 70 years or older. Such an approach c an be performed as safely as in younger patients; with comparable fate s of palliation and survival. (J Am Cell Surg 1998;187: 345-351. (C) 1 998 by the American College of Surgeons).