The Influence of Age on Complications and Overall Survival After Ivor Lewis Totally Minimally Invasive Esophagectomy

Nikolaj S Baranov,Frans Van Workum,Jolijn Van Der Maas,Ewout Kouwenhoven,Marc Van Det,Frits J.H Van Den Wildenberg,Fatih Polat,Grard A.P Nieuwenhuijzen,Misha D.P Luyer,Camiel Rosman

doi:10.1007/s11605-018-4062-9

Abstract

BackgroundThe number of elderly patients suffering from esophageal cancer is increasing, due to an increasing incidence of esophageal cancer and increasing life expectancy. However, the effect of age on morbidity, mortality, and survival after Ivor Lewis total minimally invasive esophagectomy (TMIE) is not well known. MethodsA prospectively documented database from December 2010 to June 2017 was analyzed, including all patients who underwent Ivor Lewis TMIE for esophageal cancer in three Dutch high-volume esophageal cancer centers. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Baseline patient characteristics and perioperative data were included. Surgical complications were graded using the Clavien-Dindo scale. The primary outcome was postoperative complications Clavien-Dindo ≥ 3. Secondary outcome parameters were postoperative complications, in-hospital mortality, 30- and 90-day mortality and survival. ResultsFour hundred and forty-six patients were included, 357 in the younger and 89 in the elderly group. No significant differences were recorded regarding baseline patient characteristics. There was no significant difference in complications graded Clavien-Dindo ≥ 3 and overall complications, short-term mortality, and survival. Delirium occurred in 27.0% in the elderly and 11.8% in the younger group (p < 0.001). After correction for baseline comorbidity this difference remained significant (p = 0.001). Median hospital length of stay was 13 days in the elderly and 11 days in the younger group (p = 0.010). ConclusionsIvor Lewis TMIE can be safely performed in selected elderly patients without increasing postoperative morbidity and mortality.

Highlights

The incidence of esophageal cancer is increasing, with a current incidence of 455,000 worldwide.[1]
Esophagectomy is associated with considerable morbidity and mortality and this might be higher for elderly patients since they are more frail and generally have more comorbidities than younger patients.[4, 5]
Previous studies focusing on age-related morbidity and mortality regarding esophagectomy included patients that had been treated with open esophageal resection and showed that elderly patients have an increased peri-operative and inhospital mortality risk, developed more postoperative

Summary

Introduction

The incidence of esophageal cancer is increasing, with a current incidence of 455,000 worldwide.[1] The number of elderly patients diagnosed with esophageal cancer is increasing mainly due to an increased life expectancy of the general population. The number of elderly patients suffering from esophageal cancer is increasing, due to an increasing incidence of esophageal cancer and increasing life expectancy. The effect of age on morbidity, mortality, and survival after Ivor Lewis total minimally invasive esophagectomy (TMIE) is not well known. Methods A prospectively documented database from December 2010 to June 2017 was analyzed, including all patients who underwent Ivor Lewis TMIE for esophageal cancer in three Dutch high-volume esophageal cancer centers. Secondary outcome parameters were postoperative complications, in-hospital mortality, 30- and 90-day mortality and survival

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