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10.1245/s10434-007-9455-z
Annals of Surgical Oncology 14:3243-3250 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Effects of Neoadjuvant Therapy on Perioperative Morbidity in Elderly Patients Undergoing Esophagectomy for Esophageal Cancer

Alberto Ruol, MD, FACS2, Giuseppe Portale, MD1, Carlo Castoro, MD, FACS1, Stefano Merigliano, MD2, Matteo Cagol, MD1, Francesco Cavallin, PhD1, Vanna Chiarion Sileni, MD1, Luigi Corti, MD3, Sabrina Rampado2, Mario Costantini, MD2 and Ermanno Ancona, MD, FACS1

1 Istituto Oncologico Veneto (IOV-IRCCS), Clinica Chirurgica III, University of Padova School of Medicine, Padova, Italy
2 Department of Gastroenterological and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128, Padova, Italy
3 Istituto Oncologico Veneto (IOV-IRCCS), Radiotherapy, University of Padova, School of Medicine, Padova, Italy

Correspondence: Address correspondence and reprint requests to: Carlo Castoro, MD, FACS; E-mail: carlo.castoro{at}unipd.it

Background: The use of cytoreductive therapy followed by surgery is preferred by many centers dealing with locally advanced esophageal cancer. However, the potential for increase in mortality and morbidity rates has raised concerns on the use of chemoradiation therapy, especially in elderly patients. The aim of this study was to assess the effects of induction therapy on postoperative mortality and morbidity in elderly patients undergoing esophagectomy for locally advanced esophageal cancer at a single institution.

Methods: Postoperative mortality and morbidity of patients ≥70 years old undergoing esophagectomy after neoadjuvant therapy, between January 1992 and October 2005 for cancer of the esophagus or esophagogastric junction, were compared with findings in younger patients also receiving preoperative cytoreductive treatments.

Results: 818 patients underwent esophagectomy during the study period. The study population included 238 patients <70 years and 31 ≥70 years old undergoing esophageal resection after neoadjuvant treatment. Despite a significant difference in comorbidities (pulmonary, cardiological and vascular), postoperative mortality and morbidity were similar irrespective of age.

Conclusions: Elderly patients receiving neoadjuvant therapies for cancer of the esophagus or esophagogastric junction do not have a significantly increased prevalence of mortality and major postoperative complications, although cardiovascular complications are more likely to occur. Advanced age should no longer be considered a contraindication to preoperative chemoradiation therapy preceding esophageal resection in carefully selected fit patients.

Key Words: Esophageal cancer • Esophagectomy • Neoadjuvant therapy • Elderly patients • Morbidity • Mortality • Survival






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Copyright © 2007 by the Society of Surgical Oncology.