Esophagectomy for cancer in octogenarians: should we do it?

Elizabeth Paulus, Caroline Ripat, Vadim Koshenkov, Angela T. Prescott, Kiran Sethi, Heather Stuart, Gregory Tiesi, Alan Livingstone, Danny Yakoub

Research output: Contribution to journalArticle

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Abstract

Purpose: Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer. Methods: A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years. A case-matched group of patients younger than 80 years old (n = 33) was included based on the Charlson comorbidity index with the octogenarian group (n = 33). Endpoints included operative morbidity and mortality as well as short- and long-term survival. Results: Thirty-three octogenarians met inclusion criteria. The median age was 82 years, and 79% were male; 76% had adenocarcinoma, 87% had distal esophageal, and 52% had poorly differentiated tumors. Stages 0 through III were observed in 6, 18, 27, and 48% of octogenarians, respectively. Neoadjuvant therapy was administered to 70% of patients, with 48% experiencing downstaging. Transhiatal esophagectomy was performed in 82% of patients, with R0 resection in 94%. The mean hospital stay was 18 days, with morbidity and mortality rates 56 and 9%, respectively, not significantly different from 13-day hospital stay, 45% morbidity, and 9% mortality in younger patients. Cardiac, pulmonary, and surgical site complications occurred in 24, 27, and 6% of octogenarians, respectively. Anastomotic leak occurred in 18% and reoperations in 3%. The median, 3-year survival, and 5-year survival were 21 months, 55.9%, and 37.1%, respectively. Overall survival was worse for octogenarians (p < 0.001). Conclusions: Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalLangenbeck's Archives of Surgery
DOIs
StateAccepted/In press - Mar 16 2017

Fingerprint

Esophagectomy
Neoplasms
Survival
Morbidity
Length of Stay
Mortality
Anastomotic Leak
Neoadjuvant Therapy
Esophageal Neoplasms
Reoperation
Tertiary Care Centers
Patient Selection
Comorbidity
Adenocarcinoma
Research Design
Lung

Keywords

  • Elderly
  • Esophageal cancer
  • Esophagectomy
  • Octogenarian
  • Surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Paulus, E., Ripat, C., Koshenkov, V., Prescott, A. T., Sethi, K., Stuart, H., ... Yakoub, D. (Accepted/In press). Esophagectomy for cancer in octogenarians: should we do it? Langenbeck's Archives of Surgery, 1-7. https://doi.org/10.1007/s00423-017-1573-x

Esophagectomy for cancer in octogenarians : should we do it? / Paulus, Elizabeth; Ripat, Caroline; Koshenkov, Vadim; Prescott, Angela T.; Sethi, Kiran; Stuart, Heather; Tiesi, Gregory; Livingstone, Alan; Yakoub, Danny.

In: Langenbeck's Archives of Surgery, 16.03.2017, p. 1-7.

Research output: Contribution to journalArticle

Paulus E, Ripat C, Koshenkov V, Prescott AT, Sethi K, Stuart H et al. Esophagectomy for cancer in octogenarians: should we do it? Langenbeck's Archives of Surgery. 2017 Mar 16;1-7. https://doi.org/10.1007/s00423-017-1573-x
Paulus, Elizabeth ; Ripat, Caroline ; Koshenkov, Vadim ; Prescott, Angela T. ; Sethi, Kiran ; Stuart, Heather ; Tiesi, Gregory ; Livingstone, Alan ; Yakoub, Danny. / Esophagectomy for cancer in octogenarians : should we do it?. In: Langenbeck's Archives of Surgery. 2017 ; pp. 1-7.
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abstract = "Purpose: Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer. Methods: A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years. A case-matched group of patients younger than 80 years old (n = 33) was included based on the Charlson comorbidity index with the octogenarian group (n = 33). Endpoints included operative morbidity and mortality as well as short- and long-term survival. Results: Thirty-three octogenarians met inclusion criteria. The median age was 82 years, and 79{\%} were male; 76{\%} had adenocarcinoma, 87{\%} had distal esophageal, and 52{\%} had poorly differentiated tumors. Stages 0 through III were observed in 6, 18, 27, and 48{\%} of octogenarians, respectively. Neoadjuvant therapy was administered to 70{\%} of patients, with 48{\%} experiencing downstaging. Transhiatal esophagectomy was performed in 82{\%} of patients, with R0 resection in 94{\%}. The mean hospital stay was 18 days, with morbidity and mortality rates 56 and 9{\%}, respectively, not significantly different from 13-day hospital stay, 45{\%} morbidity, and 9{\%} mortality in younger patients. Cardiac, pulmonary, and surgical site complications occurred in 24, 27, and 6{\%} of octogenarians, respectively. Anastomotic leak occurred in 18{\%} and reoperations in 3{\%}. The median, 3-year survival, and 5-year survival were 21 months, 55.9{\%}, and 37.1{\%}, respectively. Overall survival was worse for octogenarians (p < 0.001). Conclusions: Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.",
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AU - Paulus, Elizabeth

AU - Ripat, Caroline

AU - Koshenkov, Vadim

AU - Prescott, Angela T.

AU - Sethi, Kiran

AU - Stuart, Heather

AU - Tiesi, Gregory

AU - Livingstone, Alan

AU - Yakoub, Danny

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N2 - Purpose: Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer. Methods: A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years. A case-matched group of patients younger than 80 years old (n = 33) was included based on the Charlson comorbidity index with the octogenarian group (n = 33). Endpoints included operative morbidity and mortality as well as short- and long-term survival. Results: Thirty-three octogenarians met inclusion criteria. The median age was 82 years, and 79% were male; 76% had adenocarcinoma, 87% had distal esophageal, and 52% had poorly differentiated tumors. Stages 0 through III were observed in 6, 18, 27, and 48% of octogenarians, respectively. Neoadjuvant therapy was administered to 70% of patients, with 48% experiencing downstaging. Transhiatal esophagectomy was performed in 82% of patients, with R0 resection in 94%. The mean hospital stay was 18 days, with morbidity and mortality rates 56 and 9%, respectively, not significantly different from 13-day hospital stay, 45% morbidity, and 9% mortality in younger patients. Cardiac, pulmonary, and surgical site complications occurred in 24, 27, and 6% of octogenarians, respectively. Anastomotic leak occurred in 18% and reoperations in 3%. The median, 3-year survival, and 5-year survival were 21 months, 55.9%, and 37.1%, respectively. Overall survival was worse for octogenarians (p < 0.001). Conclusions: Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

AB - Purpose: Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer. Methods: A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years. A case-matched group of patients younger than 80 years old (n = 33) was included based on the Charlson comorbidity index with the octogenarian group (n = 33). Endpoints included operative morbidity and mortality as well as short- and long-term survival. Results: Thirty-three octogenarians met inclusion criteria. The median age was 82 years, and 79% were male; 76% had adenocarcinoma, 87% had distal esophageal, and 52% had poorly differentiated tumors. Stages 0 through III were observed in 6, 18, 27, and 48% of octogenarians, respectively. Neoadjuvant therapy was administered to 70% of patients, with 48% experiencing downstaging. Transhiatal esophagectomy was performed in 82% of patients, with R0 resection in 94%. The mean hospital stay was 18 days, with morbidity and mortality rates 56 and 9%, respectively, not significantly different from 13-day hospital stay, 45% morbidity, and 9% mortality in younger patients. Cardiac, pulmonary, and surgical site complications occurred in 24, 27, and 6% of octogenarians, respectively. Anastomotic leak occurred in 18% and reoperations in 3%. The median, 3-year survival, and 5-year survival were 21 months, 55.9%, and 37.1%, respectively. Overall survival was worse for octogenarians (p < 0.001). Conclusions: Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

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KW - Octogenarian

KW - Surgery

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