[Operative indications and treatment in elderly patients with esophageal cancer]

A recent study indicates that infection of human papillomavirus (HPV) may cause esophageal cancer and that it takes several decades from infection of HPV to developing cancer. Even in early stage esophageal cancer, lymph node metastasis is usually observed in the mediastinum, abdomen and neck regions. As patients with esophageal cancer are potentially in a malnutritional state because of disturbance of intake before treatment, active nutritional support should be performed before and after surgery. An objective nutritional assessment is necessary for nutritional support. The nutritional assessment index (NAI) can be applied to elderly patients because there is no difference in nutritional parameters between elderly and young patients. From the point of view that surgical treatment has limitations concerning complete curability, we employed a remote after loading system (RALS) into a multidisciplinary treatment called the Kochi system, which consists of a combination of surgery, radiation therapy and chemotherapy. This multidisciplinary method of treatment greatly contributes to survival and quality of life of esophageal cancer patients especially in elderly cases.