Han Yu, Liu Shengjun, Guo Wei, Zhang Yajie, Li Hecheng
Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Shanghai Jiaotong University School of Medicine, Shanghai, China.
Interact Cardiovasc Thorac Surg. 2019 Dec 1;29(6):897-905. doi: 10.1093/icvts/ivz208.
The surgical efficacy of oesophagectomy for elderly patients (>80 years old) is still unclear. The aim of this meta-analysis was to compare the clinical outcomes of oesophagectomy between elderly and relatively younger patients.
PubMed, EMBASE and the Cochrane Library were searched for relevant studies comparing the clinical outcomes of oesophagectomy for elderly and relatively younger patients. Odds ratios were extracted to obtain pooled estimates of the perioperative effect, and hazard ratios were extracted to compare survival outcomes between the 2 cohorts.
Nine studies involving 4946 patients were included in this meta-analysis. For patients older than 80 years of age, in-hospital mortality [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.28-3.13; P = 0.002] and the incidence rates of cardiac (OR 1.55, 95% CI 1.10-2.20; P = 0.01) and pulmonary (OR 1.57, 95% CI 1.11-2.22; P = 0.01) complications were higher than those of relatively younger patients. The overall postoperative complication rate (OR 1.40, 95% CI 0.82-2.40; P = 0.22) and the incidence of anastomotic leak (OR 0.92, 95% CI 0.58-1.47; P = 0.73) were not significantly different between the 2 groups. Elderly patients had a worse overall 5-year survival rate (HR 2.66, 95% CI 1.65-4.28; P < 0.001) than that of relatively younger patients. The cancer-related 5-year survival rate of elderly patients was also lower than that of relatively younger patients (HR 3.37, 95% CI 2.36-4.82; P < 0.001).
Compared with relatively younger patients, elderly patients with oesophageal cancer undergoing oesophagectomy are at higher risk of in-hospital mortality and have lower survival rates. However, there is no conclusive evidence that the overall rate of complications is elevated in elderly patients.
食管癌切除术对于老年患者（年龄>80岁）的手术疗效仍不明确。本荟萃分析的目的是比较老年患者与相对年轻患者行食管癌切除术后的临床结局。
检索PubMed、EMBASE和Cochrane图书馆，查找比较老年患者与相对年轻患者行食管癌切除术后临床结局的相关研究。提取比值比以获得围手术期效应的合并估计值，并提取风险比以比较两组之间的生存结局。
本荟萃分析纳入了9项研究，共4946例患者。对于年龄大于80岁的患者，其住院死亡率[比值比（OR）2.00，95%置信区间（CI）1.28 - 3.13；P = 0.002]以及心脏（OR 1.55，95% CI 1.10 - 2.20；P = 0.01）和肺部（OR 1.57，95% CI 1.11 - 2.22；P = 0.01）并发症的发生率均高于相对年轻的患者。两组的总体术后并发症发生率（OR 1.40，95% CI 0.82 - 2.40；P = 0.22）和吻合口漏发生率（OR 0.92，95% CI 0.58 - 1.47；P = 0.73）无显著差异。老年患者的总体5年生存率（风险比2.66，95% CI 1.65 - 4.28；P < 0.001）低于相对年轻的患者。老年患者的癌症相关5年生存率也低于相对年轻的患者（风险比3.37，95% CI 2.36 - 4.82；P < 0.001）。
与相对年轻的患者相比，行食管癌切除术的老年食管癌患者住院死亡风险更高，生存率更低。然而，尚无确凿证据表明老年患者的总体并发症发生率升高。
