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Esophageal Resection for Carcinoma in Patients Older Than 70 Years

From the Roswell Park Cancer Institute and State University of New York at Buffalo, Buffalo, New York.

Correspondence: Address correspondence and reprint requests to: John F. Gibbs, MD, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263; Fax: 716-845-3434; E-mail: john.gibbs{at}roswellpark.org

Background: A larger number of older patients are presenting as candidates for esophageal resection. An aggressive surgical approach in this population is controversial.

Methods: Four hundred thirteen patients with esophageal cancer who presented to Roswell Park Cancer Institute from 1991 to 1998 were retrospectively reviewed. Clinical data, perioperative details, and postoperative courses were compared for patients older and younger than 70 years.

Results: One hundred forty-seven patients (36%) were older than 70 years. Risk factors, clinical symptoms, histology, and stage at presentation were equivalent for both age groups. A higher percentage of patients <70 years were candidates for curative resection. There were no significant differences between groups for estimated blood loss, intraoperative transfusions, length of stay, overall morbidity, or mortality. Only postoperative myocardial infarction and atrial fibrillation were increased in the older group. Excluding stage IV disease, there was a significant and similar improvement in median survival after resection for patients both <70 years and >70 years.

Conclusions: In conclusion, esophageal cancer in older patients warrants surgical resection because the benefit to the patient is the same as it is for younger patients, without a significant increase in operative morbidity or mortality.

Key Words: Esophageal cancer • Esophagectomy • Advanced age • Aggressive surgical approach • Postoperative complications • Prognosis

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