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News

Elderly age and outcome after surgical resection of esophageal malignancy

This month's issue of the Diseases of the Esophagus investigates elderly age and outcome following surgical resection of esophageal malignancy.

News image

The incidence of esophageal malignancy continues to increase worldwide.

At the same time, average life expectancy levels continue to climb, ensuring that more patients will present in their 70s, 80s, and 90s.

Dr Donald Low and colleagues Washington, USA conducted a pooled analysis to compare short- and long-term outcomes for elderly and younger patients undergoing esophagectomy for malignancy.

Studies comparing the outcomes of esophagectomy for malignancy in elderly and young cohorts of patients were included.

The research team's minimum threshold age used to define the elderly cohort was 70 years.

Esophagectomy in elderly patients was associated with increased in-hospital mortality
Gut

Primary outcomes were in-hospital mortality, overall and cancer-related 5-year survival.

Secondary outcomes were the length of hospital stay, the incidence of anastomotic leak, conduit ischemia, cardiac and pulmonary complications, and the use of neoadjuvant therapy.

The research team analyzed 25 publications comprising 9531 and 2573 operations on younger, and elderly cohorts of patients, respectively.

The researchers found that elderly patients were less likely to receive neoadjuvant therapy.

Esophagectomy in elderly patients was associated with increased in-hospital mortality, as well as increased pulmonary, and cardiac complications.

The team found that subset analysis of studies using an age threshold of 80 years showed an even more significant association between in-hospital mortality and elderly age.

There were no significant differences between the groups in length of hospital stay, incidence of anastomotic leak, or conduit ischemia.

The researchers found that the elderly group showed reduced overall 5-year survival, and reduced cancer-free 5-year survival.

Elderly patients are at increased risk of pulmonary and cardiac complications, and perioperative mortality following esophagectomy, and show reduced cancer-related 5-year survival compared with younger patients.

Dr Low's team concluded, "These patients represent a high-risk cohort, who requires thorough assessment of medical comorbidity, targeted counseling, and optimized treatment pathways."

Dis Esoph 2013: 26(3): 250–262
10 April 2013

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