Minimally invasive esophagectomy in the elderly.

Area of Science:

• Surgical Oncology
• Gastroenterology
• Geriatric Medicine

Background:

• Minimally invasive esophagectomy is increasingly used for esophageal cancer.
• Elderly patients (>70 years) present unique challenges for surgical interventions.

Purpose of the Study:

• To evaluate the safety and feasibility of thoracolaparoscopic esophagectomy in elderly patients (>70 years).
• To determine if advanced age is a limiting factor for minimally invasive esophagectomy in esophageal cancer patients.

Main Methods:

• Retrospective analysis of a prospectively maintained database.
• Inclusion of patients >70 years with T1/2/3, N0/1 mid/lower esophageal or gastroesophageal junction tumors (AJCC 6th ed.).
• Exclusion of patients with ASA grade IV; evaluation of perioperative outcomes from January 2009 to January 2012.

Main Results:

• Sixty-eight elderly patients (average age 75.76 years) underwent thoracolaparoscopic esophagectomy.
• Mean operative time: 178.84 min; mean blood loss: 143.84 ml.
• Low complication rates: 10.30% pneumonia, 1.47% cardiac; no conversions to open thoracotomy.

Conclusions:

• Thoracolaparoscopic esophagectomy is feasible and surgically safe in elderly patients.
• The procedure is associated with low morbidity and mortality in this age group.
• Patient age should not be considered a limiting factor for minimally invasive esophagectomy for esophageal cancer.