Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

AIM:To evaluate the risk of esophagectomy for carci-noma of the esophagus in the elderly(70 years or more)compared with younger patients(<70 years)and to de-termine whether the short-term outcomes of esophagec-tomy in the elderly have improved in recent years.METHODS:Preoperative risks,postoperative morbid-ity and mortality in 60 elderly patients(≥70 years)withesophagectomy for carcinoma of the esophagus werecompared with the findings in 1 782 younger patients(<70 years)with esophagectomy between January 1990and December 2004.Changes in perioperative outcomeand short-time survival in elderly patients between 1990to 1997 and 1998 to 2004 were separately analyzed.RESULTS:Preoperatively,there were significantly morepatients with hypertension,pulmonary dysfunction,car-diac disease,and diabetes mellitus in the elderly patientsas compared with the younger patients.No significantdifference was found regarding the operation time,bloodloss,organs in reconstruction and anastomotic site be-tween the two groups,but elderly patients were moreoften to receive blood transfusion than younger patients.Significantly more transhiatal and fewer transthoracicesophagectomies were performed in the elderly pa-tients as compared with the younger patients.Resectionwas considered curative in 71.66%(43/60)elderly and64.92%(1 157/1 782)younger patients,which was notstatistically significant(P>0.05).There were no signifi-cant differences in the prevalence of surgical complica-tions between the two groups.Postoperative cardiopul-monary medical complications were encountered morefrequently in elderly patients.The hospital mortality ratewas 3.3%(2/60)for elderly patients and 1.1%(19/1782)for younger patients without a significant differ-ence.When the study period was divided into a former(1990 to 1997)and a recent(1997 to 2004)period, operation time,blood loss,and percentage of patientsreceiving blood transfusion of the elderly patients sig-nificantly improved from the former period to the recentperiod.The hospital mortality rate of the elderly patientsdropped from the former period(5.9%)to the recentperiod(2.3%),but it was not statistically significant.CONCLUSION:Preoperative medical risk factors andpostoperative cardiopulmonary complications afteresophagectomy are more common in the elderly,butoperative mortality is comparable to that of youngerpatients.These encouraging results and improvementsin postoperative mortality and morbidity of the elderlypatients in recent period are attributed to better surgicaltechniques and more intensive perioperative care in theelderly.