Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Dis Esophagus. 2010 Nov;23(8):666-9. doi: 10.1111/j.1442-2050.2010.01081.x.
Because of changes in life expectancy, there is an increasing number of elderly patients with esophageal cancer. The aim of this study was to assess the outcome of esophagectomy for cancer in patients 80 years or older. A retrospective review was performed of the records of all patients who underwent esophagectomy for cancer from 1992 to 2007. A cardiac and pulmonary evaluation was obtained on an individual basis in the younger patients and in all octogenarians. Among 560 patients with esophagectomy for cancer, 47 patients (8%) were octogenarians. The median age of the younger group (n= 513) was 63 years (interquartile range 56-71). Octogenarians had significantly more stage III disease (49% vs 31%, P= 0.02) but received less neoadjuvant therapy than younger patients (2% vs 21%, P= 0.0004). In octogenarians, the transhiatal resection was more common than in the younger group (79% vs 36%, P < 0.0001). Weight loss prior to surgery was similar in both groups, but body mass index was significantly lower in octogenarians (25 vs 28 kg/m(2) , P= 0.0002). Major complications occurred in 26% in octogenarians and 31% in the younger group (P= 0.51). Hospital mortality was similar (9% for octogenarians vs 4% in the younger group, P= 0.13). The median postoperative hospital stay was similar at 16 days (P= 0.69). There was no difference in cancer-related survival (median survival 48.9 vs 59.3 months, P= 0.31 log-rank test). Esophagectomy can be performed safely in carefully selected octogenarians with good cardiac and pulmonary function. Patients should not be denied an esophagectomy based only on their age.
由于预期寿命的变化，患有食管癌的老年患者数量不断增加。本研究旨在评估 80 岁或以上食管癌患者接受手术的结果。对 1992 年至 2007 年间接受食管癌切除术的所有患者的记录进行了回顾性分析。对年轻患者和所有 80 岁以上的患者进行了心脏和肺部评估。在 560 例接受食管癌切除术的患者中，47 例（8%）为 80 岁以上的老年人。年轻组（n=513）的中位年龄为 63 岁（四分位间距 56-71）。80 岁以上患者的 III 期疾病明显更多（49%比 31%，P=0.02），但接受的新辅助治疗少于年轻患者（2%比 21%，P=0.0004）。在 80 岁以上的患者中，经食管裂孔切除术比年轻组更常见（79%比 36%，P<0.0001）。两组术前体重减轻相似，但 80 岁以上患者的体重指数明显较低（25 比 28 kg/m²，P=0.0002）。两组的主要并发症发生率相似（80 岁以上患者为 26%，年轻患者为 31%，P=0.51）。医院死亡率相似（80 岁以上患者为 9%，年轻患者为 4%，P=0.13）。术后住院中位时间相似，为 16 天（P=0.69）。癌症相关生存率无差异（中位生存时间 48.9 比 59.3 个月，P=0.31 对数秩检验）。在仔细选择的具有良好心脏和肺功能的 80 岁以上患者中，可以安全地进行食管切除术。不应仅根据年龄拒绝为患者进行食管切除术。
