Radical esophagectomy in elderly patients with esophageal cancer

Background: The increasing lifespan of the aging population has resulted in an increased number of elderly patients with esophageal cancer. Purpose: This study was conducted to determine the effects of age on outcomes following surgery in elderly patients with esophageal cancer. Methods: Patients with esophageal cancer who received curative esophagectomy between January 2001 and December 2012 were enrolled in this study. The patients were divided into two groups according to their age at diagnosis: Group 1 comprised patients aged ≥70 years and Group 2 comprised patients aged <70 years. Perioperative variables, the length of hospital stay, rates of surgery-related morbidity and mortality, and survival outcomes were analyzed and compared between the two groups. Results: The study comprised 185 patients, with 39 patients in Group 1 and 146 patients in Group 2. Perioperative variables, namely pulmonary function, chemoradiotherapy, length of intensive care unit stay (4.5 days vs. 3.1 days), and hospital stay (30.2 days vs. 21.6 days), were significantly different between the two groups. The patients in Group 1 showed higher mortality (7.7% vs. 3.4%) and morbidity (46.1% vs. 29.5%) compared with those in Group 2, with no statistical significance. Cardiopulmonary-related complications (30.8%) following esophagectomy were most frequently observed in elderly patients. With less intensive chemotherapy and/or radiotherapy, the overall survival of the patients in Group 1 was prolonged compared with that of the patients in Group 2 (15.8 months vs. 13.7 months, p = 0.44). Esophagectomy followed by chemoradiotherapy did not yield more positive outcomes than those of esophagectomy alone in patients in Group 1. Conclusion: Esophagectomy in elderly patients with esophageal cancer can yield an acceptable outcome and fewer complications than esophagectomy in younger patients. Although reserved physiological functions are typically limited in elderly patients relative to younger patients, elderly patients with resectable esophageal cancer should not be denied esophagectomy.