Title: Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years
Authors: Internullo, Eveline ×
Moons, Johnny
Nafteux, Philippe
Coosemans, Willy
Decker, Georges
De Leyn, Paul
Van Raemdonck, Dirk
Lerut, Antoon #
Issue Date: Jun-2008
Publisher: Elsevier Science
Series Title: European Journal of Cardio-Thoracic Surgery vol:33 issue:6 pages:1096-1104
Abstract: objective: Though the surgical treatment of esophageal cancer is increasingly accepted for elderly people defined as aged over 70 years, less is for cancer of the esophagus and GEJ in patients aged over 75 years. Methods: All, consecutive patients 76 years old and over undergoing curative esophagectomy for cancer in the period 1991-2006 were analyzed as to comorbidities, outcome and long-term survival. All the data had been prospectively collected in a database. Postoperative mortality risk was assessed by P-POSSUM and O-POSSUM score for in-hospital mortality and by the recently published Steyerberg's score system [Steyerberg EW, Neville BA, Koppert LB, Lemmens VEPP, Tilanus HW, Coebergh JWW, Weeks JC, Earle CC. Surgical mortality in patients with esophageal. cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277-84.] for 30-day mortality. Five-year survival was compared to the standardized survival in the general population. Results: One hundred and eight patients fulfilling the abovementioned criteria were found (76 mates and 32 females, mean age 79.5 years, mean standardized life-expectancy: 7.36 years). Among them, 69% had esophageal tumors and 31% GEJ tumors. The predominant histology was adenocarcinoma (74%). Eighty-six (79.6%) presented with one or more major comorbidities or a history of previous major upper-G] surgery, potentially affecting the surgical outcome. All underwent resection with curative intent (R-0 83.3%, R-1 12%, R-2 4.6%). The overall postoperative morbidity rate was 51.9%, pulmonary complications (37%) being the most frequent. Postoperative mortality, mainly due to cardiopulmonary complications, was 7.4%, which was consistent with that predicted by P-POSSUM score (7.2%) and lower than that predicted by O-POSSUM score (15.1%). Thirty-day mortality was 5.5%, being consistent with that predicted by the Steyerberg's score (6.8%). Overall 5-year survival was 35.7%, white R-0 overall survival 42% and cancer specific R-0 survival 51.7%. Conclusions: Patients 76 years old and over with esophageal. or GEJ cancer should not be denied surgery solely on the basis of age. Outcome and tong-term results in the selected elderly are not differing from those reported for younger patients. However, despite thorough preoperative assessment being applied in the selection of the candidates for surgery, a practical and reliable individual risk-analysis stratification is stilt lacking. (c) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All. rights reserved.
ISSN: 1010-7940
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Thoracic Surgery
Laboratory of Abdominal Transplantation
× corresponding author
# (joint) last author

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