The Impact Of Age On Patients Undergoing Transthoracic Esophagectomy For Cancer

To compare long-term and short-term outcomes in patients <70 years old with those >= 70 years old, who underwent transthoracic esophagectomy for carcinoma. With an ageing population more patients, with increasing co-morbidities are being diagnosed with potentially curable esophageal cancer. Concerns exist regarding offering older patients esophagectomy, conversely undue prejudice may exists that may prevent surgery being offered. Consecutive patients from a single unit between January 2000 and July 2016 that underwent trans-thoracic esophagectomy with or without neoadjuvant treatment for carcinoma were included. Short-term outcomes including morbidity, mortality, length of stay and long-term survival were compared between those <70 and those >= 70. This study identified 992 patients who underwent esophagectomy during the study period, of which 302 (30%) >= 70 years old. Greater proportion >= 70 years old had SCC (squamous cell carcinoma) (23%) than <70 (18%) (p = 0.07). Patients >= 70 years old were noted to have higher ASA Grade 3 (34% vs 25%, p = 0.004) and were less likely to receive neoadjuvant treatment (64% vs 45%p<0.001). Length of stay was longer in >= 70 (14 vs 17 days p<0.001), and there were more complications (63% vs 75% p < 0.001). In hospital mortality was higher in >= 70 (2% vs 5% p = 0.026). Overall survival was 50 months in <70 vs 36 months in >= 70 (p = <0.001). In <70s with adenocarcinoma, overall survival was 52 months vs 35 months in the >= 70 (p < 0.001). No significant difference in survival in patients with SCC, 49 months in <70 vs 54 months in >= 70 (p = 0.711). Increased peri-operative morbidity and mortality combined with the reduction in the long term survival in the over 70s cohort should be addressed when counselling patients undergoing curative resection for oesophageal cancer.