Abstract
121 Background: Studies evaluating the outcome of esophectomy (Esx) in elderly patients (pts) with esophageal cancer (EC) have showed conflicting results. Surgical techniques in Esx have advanced significantly in the last decade. Our study evaluates national trends and outcomes of Esx in elderly pts. Methods: Our analysis includes adult pts aged < 70, 70-79 and > 79 in the Nationwide Inpatient Sample who underwent Esx 2002-2012. We examined temporal trends and performed multivariate analysis for key outcomes controlling for demographics, hospital factors and comorbidities. Results: Inpatient mortality was higher in pts aged > 79 (17%; OR 3.24, 95 CI 2.05, 5.12 N = 1,464) and pts 70-79 (9%; OR 1.44, 95% CI 1.01, 2.06; N = 7,393) compared to pts < 70 (5.26%; N = 20,730). Complication rates and length of stay were 76%, 73% and 64%, and 19.2, 18.4 and 17.1 days in the three age groups, respectively. Inpatient mortality improved significantly for all age groups over the study period (Table). Following Esx, 47%, 64% and 82% of pts aged > 79, 70-79 and < 70, were discharged home, respectively. Across all age groups, most pts (74.7%, 75.6 % and 79.4%, respectively) underwent Esx in urban teaching hospitals. On multivariate analysis for pts aged ≥ 70, rural nonteaching hospitals were associated with higher mortality compared to urban teaching hospitals (OR: 3.18, CI 1.47, 6.86). Complication rates were not significantly different between the two hospital settings. Mortality was higher with congestive heart failure (OR 1.86, 95% CI 1.08, 3.23), chronic lung disease (OR 1.91, CI 1.32, 2.76) and peripheral vascular disease (OR 2.41, CI 1.18, 4.92). Conclusions: Inpatient mortality following Esx has significantly improved over the last decade but remains high in elderly pts especially in nonteaching hospitals. Our data should aid multidisciplinary teams in counseling elderly pts about mortality risk of surgery. Further research is needed to better select elderly patients who will benefit from surgical resection. [Table: see text]
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