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Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
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Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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Does age affect oesophagectomy survival: a cohort study.

Jin-Soo Park1,2, Hans Van der Wall2,3, Catherine W Kennedy4

  • 1Department of Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

ANZ Journal of Surgery
|December 28, 2020
PubMed
Summary

Older patients (75+) undergoing curative oesophagectomy for oesophageal cancer show similar survival and mortality rates to younger patients. Age alone should not disqualify elderly individuals from this potentially life-saving surgery when performed with acceptable risk.

Keywords:
agecarcinoma oesophagusoesophagectomy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Geriatric Medicine

Background:

  • Oesophageal cancer treatment, particularly curative oesophagectomy, carries significant mortality risks.
  • An aging global population leads to an increasing number of older patients with oesophageal cancer.
  • Concerns exist regarding the suitability and outcomes of oesophagectomy in elderly patients, especially those unfit for multimodal therapy.

Purpose of the Study:

  • To evaluate the impact of advanced age on overall survival (OS) and disease-free survival (DFS) following curative oesophagectomy for oesophageal cancer.
  • To compare survival outcomes between patients younger than 75 years and those aged 75 years or older undergoing oesophagectomy.
  • To determine if age is an independent contraindication for potentially curative oesophagectomy.

Main Methods:

  • Analysis of a prospectively maintained database of patients who underwent oesophagectomy for oesophageal cancer between 1990 and 2019.
  • Stratification of patients into two groups: <75 years and ≥75 years.
  • Comparison of demographic, surgical, and survival outcomes, including 30-day mortality, 5-year OS, median survival, and 5-year DFS.

Main Results:

  • A total of 351 patients were analyzed (283 <75 years, 68 ≥75 years).
  • The 30-day mortality rates were comparable between the younger and older groups (2.5% vs. 2.9%, P=0.827).
  • No statistically significant differences were observed in 5-year OS (50.3% vs. 38.6%, P=0.082), median survival (22.6 vs. 19.3 months, P=0.053), or 5-year DFS (45.1% vs. 35.7%, P=0.180) between the age groups.

Conclusions:

  • Patients aged 75 years and older experience comparable overall survival, disease-free survival, and 30-day mortality rates to their younger counterparts after curative oesophagectomy.
  • Age alone should not be a reason to exclude elderly patients from consideration for potentially curative oesophagectomy.
  • Careful patient selection and assessment of surgical risk are crucial for optimizing outcomes in older patients undergoing oesophagectomy.