Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
J Surg Res. 2021 Mar;259:538-545. doi: 10.1016/j.jss.2020.10.006. Epub 2020 Nov 6.
Octogenarians with esophageal cancer typically have a poor physical condition, reduced physiological reserves, and high postoperative mortality (POM). Extensive lymph node dissection increases surgical trauma and postoperative complications. The purpose of this study was to examine the associations between the number of dissected lymph nodes and short-term and long-term postoperative outcomes in octogenarians with thoracic esophageal cancer.
We examined the data of patients from the Surveillance, Epidemiology, and End Results database. We divided the patients into two groups in accordance with the number of lymph nodes dissected: patients with <15 examined lymph nodes (eLNs) and patients with ≥15 eLNs. Mortality was quantified at 30, 60, and 90 d after surgery. Univariable and multivariable logistic regression analyses were performed to identify predictors of 90-day mortality. Kaplan-Meier analysis and the log-rank test were used to analyze the overall survival and cause-specific survival of the patients.
A total of 208 octogenarians with thoracic esophageal cancer were included in the analysis. The 30-day POM rates were 10.3% and 6.9%, the 60-day POM rates were 16.9% and 13.9%, and the 90-day POM rates were 21.3% and 19.4% for patients with <15 eLNs and ≥15 eLNs, respectively. However, the differences in POM between the two groups were statistically nonsignificant (all P > 0.05). In accordance with the multivariable logistic regression analysis, age and marital status were significantly associated with 90-day POM. Furthermore, no significant difference was found between the groups in terms of long-term survival. The 5-year overall survival rates were 29% and 26.8% (P = 0.719) and the 5-year cause-specific survival rates were 43.2% and 34.1% (P = 0.446) in patients with <15 eLNs and ≥15 eLNs, respectively.
We have demonstrated that octogenarians undergoing esophagectomy are associated with an unacceptably high POM, and less extensive lymph node resection does not decrease POM. Octogenarians may not benefit from esophagectomy with lymphadenectomy. Additional studies need to be conducted to further guide clinicians performing highly selective esophagectomy.
患有食管癌的 80 岁以上老年人通常身体状况不佳，生理储备减少，术后死亡率（POM）较高。广泛的淋巴结清扫会增加手术创伤和术后并发症。本研究旨在探讨 80 岁以上胸段食管癌患者淋巴结清扫数量与短期和长期术后结果的关系。
我们查阅了 Surveillance, Epidemiology, and End Results 数据库中的患者数据。我们根据清扫的淋巴结数量将患者分为两组：淋巴结清扫数<15 个（eLNs）的患者和淋巴结清扫数≥15 个的患者。术后 30、60 和 90 天分别量化死亡率。采用单变量和多变量逻辑回归分析确定 90 天死亡率的预测因素。Kaplan-Meier 分析和对数秩检验用于分析患者的总生存率和特定原因生存率。
共纳入 208 例 80 岁以上胸段食管癌患者。淋巴结清扫数<15 个和≥15 个的患者术后 30 天 POM 率分别为 10.3%和 6.9%，60 天 POM 率分别为 16.9%和 13.9%，90 天 POM 率分别为 21.3%和 19.4%。然而，两组间 POM 差异无统计学意义（均 P>0.05）。多变量逻辑回归分析显示，年龄和婚姻状况与 90 天 POM 显著相关。此外，两组患者的长期生存率无显著差异。淋巴结清扫数<15 个和≥15 个的患者 5 年总生存率分别为 29%和 26.8%（P=0.719），5 年特定原因生存率分别为 43.2%和 34.1%（P=0.446）。
我们的研究表明，接受食管癌切除术的 80 岁以上老年人的 POM 较高，较少的淋巴结清扫并不能降低 POM。80 岁以上老年人可能不能从淋巴结清扫的食管癌切除术获益。需要进一步的研究来进一步指导临床医生进行高度选择性的食管癌切除术。
