Esophagectomy in the septuagenarian

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Geriatric Medicine

Background:

• Aging population leads to increased referrals for thoracic surgical procedures in older adults.
• Esophageal carcinoma presents unique challenges in elderly patients due to comorbidities and physiological changes.

Purpose of the Study:

• To evaluate the outcomes of esophagectomy in patients aged 70 years or older with primary esophageal carcinoma.
• To assess the operative mortality, morbidity, and long-term survival rates in this specific patient cohort.

Main Methods:

• Retrospective review of 38 patients (≥70 years) who underwent esophagectomy for esophageal cancer between 1985 and 1992.
• Data collected included patient demographics, tumor histology, preoperative treatment, surgical approach, operative complications, and survival.
• Histologic subtypes included adenocarcinoma (74%) and squamous cell carcinoma (26%).

Main Results:

• Overall operative mortality was 18% (7 of 38).
• Major morbidities included pneumonia (29%), anastomotic leak (11%), and chylothorax (11%).
• Three patients achieved long-term survival (65-72 months), and 7 additional patients were alive at follow-up.

Conclusions:

• Esophagectomy in elderly patients (≥70 years) for esophageal cancer is associated with significant operative mortality and morbidity.
• Despite risks, selected older patients may achieve long-term survival, warranting careful consideration of surgical candidacy.
• Further research is needed to optimize management strategies for esophageal cancer in the geriatric population.