Clinical outcome and long-term survival rates after esophagectomy are not determined by age over 70 years

Abstract

Esophagectomy is considered a high-risk procedure in patients aged 70 years or older. This study evaluates the impact of two age groups (younger than 70 and 70 years or older) on clinical outcome and longterm survival rates following this procedure. This prospective study included survival analysis and clinical evaluations at 3, 6, and 12 months after esophagectomy. All esophagectomy patients undergoing gastric (n = 125), jejunal (n = 10), or colonic (n = 4) reconstructions at our institution from 1984 to 1996 were included. Fifty patients were older than 70 years, 89 were younger, and 120 of these 139 patients had tumors. The overall hospital mortality rate was 1.4% (2 of 139), both in the younger age group. All leaks from anastomoses and grafts were nonfatal, and these problems occurred in seven patients in the younger age group and two in the older group. The mean preoperative weight was 70 kg, and there was a mean weight loss of 5 kg during the first three postoperative months only but none thereafter ( P <0.001). This was the same for patients with benign and malignant disorders, and for those aged over or under 70 years. Between 71% and 77% of the patients experienced no dysphagia at the three evaluations during the first postoperative year. The distribution of the different grades of dysphagia was equal in the two age groups at 3-month ( P = 0.339) and 12-month ( P = 0.669) follow-up. The 12-year survival rate was 28% and the 5-year rate was 31%, and this was correlated to tumor stage ( P = 0.002) but not to age over or under 70 years ( P = 0.299). The clinical outcome was the same regardless of whether patients were over or under 70 years of age. Tumor stage but not age over 70 years was the major predictive factor for long-term survival.