Physiology, Not Chronology, Dictates Outcomes after Esophagectomy for Esophageal Cancer: Outcomes in Patients 80 Years and Older

Abstract

To assess short and long-term outcomes for patients aged ≥80 years undergoing esophagectomy for malignancy. All patients undergoing esophagectomy for cancer between 1991 and 2011 had information prospectively entered into a database; patients were divided into elderly (≥80 years) and younger (<80 years) groups. Of the 500 patients included, 32 (6.4%) were ≥80 years of age. Octogenarians had increased Charlson comorbidity index and were less likely to receive neoadjuvant chemoradiotherapy (6.3 vs. 39.7%). Analysis of operative time, estimated blood loss, and length of intensive care unit and hospital stay revealed no significant differences between the groups. Patients ≥80 years old had increased total postoperative morbidity (68.8 vs. 44.9%), specifically arrhythmia (31.3 vs. 16.7%) and pneumonia (18.8 vs. 8.3%). There were no in-hospital mortalities in patients ≥80 years (0 vs. 0.4%), and there was no significant difference in overall survival between the groups (53.2 ± 9.1 vs. 77.6 ± 4.8 months; P = 0.58). Subset analysis demonstrated similar morbidity and length of hospital stay for patients between 70 and 79 years (n = 132) and those ≥80 years. Elderly patients undergoing esophagectomy are at greater risk of postoperative complications. However, there were no significant differences in other major parameters, including length of hospital stay, mortality, and survival, indicating that selected patients ≥80 years old can and should be assessed by an experienced surgeon.