Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.
Dis Esophagus. 2021 Feb 10;34(2). doi: 10.1093/dote/doaa056.
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.
为了比较 70 岁以下和 70 岁以上患者接受胸段食管癌切除术的长期和短期结果。随着人口老龄化，越来越多的患者伴有日益增多的合并症，被诊断为可治愈的食管癌。对于年龄较大的患者，人们对其进行食管癌切除术存在顾虑，但可能存在过度偏见，导致手术无法进行。本研究纳入了 2000 年 1 月至 2016 年 7 月期间在单一中心接受胸段食管癌切除术（包括新辅助治疗）的连续患者。比较了 70 岁以下和 70 岁以上患者的短期结果，包括发病率、死亡率、住院时间和长期生存率。本研究期间共 992 例患者接受了食管癌切除术，其中 302 例（30%）年龄≥70 岁。≥70 岁患者的 SCC（鳞状细胞癌）比例（23%）高于<70 岁患者（18%）（p=0.07）。≥70 岁患者的 ASA 分级 3 级比例更高（34%比 25%，p=0.004），且接受新辅助治疗的比例更低（64%比 45%，p<0.001）。≥70 岁患者的住院时间更长（14 天比 17 天，p<0.001），并发症更多（63%比 75%，p<0.001）。≥70 岁患者的院内死亡率更高（2%比 5%，p=0.026）。<70 岁患者的总体生存率为 50 个月，≥70 岁患者为 36 个月（p<0.001）。<70 岁的腺癌患者总体生存率为 52 个月，≥70 岁患者为 35 个月（p<0.001）。≥70 岁患者的 SCC 生存率无显著差异，分别为 49 个月和 54 个月（p=0.711）。在为接受食管癌根治性切除术的患者提供咨询时，应考虑 70 岁以上患者围手术期发病率和死亡率增加以及长期生存率降低的问题。
