Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA.
The University of Queensland-Ochsner Clinical School, New Orleans, LA.
J Am Coll Surg. 2021 Apr;232(4):580-588. doi: 10.1016/j.jamcollsurg.2020.11.027. Epub 2021 Feb 4.
Optimal curative therapy for locally advanced esophageal and esophagogastric junction (EGJ) cancer might not be offered to elderly patients due to patient and treating physician perception of the high risk of therapy. To understand the risk of multimodality curative therapy, including surgical resection in the elderly population, we studied our experience with curative therapy in this patient population and compared the risks and outcomes with those in a younger population.
Between January 1, 2004 and December 31, 2019, four hundred and five consecutive patients with esophageal or EGJ cancer underwent primary treatment at our institution, including esophagectomy. Data collected included demographic information, tumor stage, preoperative Charlson Comorbidity Index scores, treatment variables, and short- and long-term outcomes. Patients who were 70 years or older were classified as the "older" group and patients younger than 70 years were "younger."
One hundred and eighty-eight younger (mean age 59 years) and 94 older (mean age 74 years) patients received neoadjuvant chemoradiotherapy and surgical resection for stage II and higher cancer. Preoperative American Society of Anesthesiologist and Charlson Comorbidity Index scores were significantly worse in the older group. Postoperative atrial fibrillation and urinary retention developed more often in the older group. Despite this, the rate of postoperative Clavien-Dindo complication severity scores of 3 or higher, perioperative mortality rates, and lengths of stay were similar. Long-term age-adjusted survival rate was 44.8% at 5 years for the group 70 years or older and 39% for the group younger than 70 years (NS).
Patients 70 years and older with locally advanced esophageal or EGJ cancer should be evaluated for optimal curative therapy including neoadjuvant chemoradiotherapy and surgical resection. Although preoperative risk scoring and postoperative atrial arrythmias are higher in the older group, short- and long-term outcomes are not inferior in these patients.
由于患者和治疗医生认为治疗风险较高，局部晚期食管和食管胃交界（EGJ）癌的最佳治疗方法可能无法提供给老年患者。为了了解包括手术切除在内的多模式根治性治疗的风险，我们研究了我们在该患者人群中的根治性治疗经验，并将其风险和结果与年轻患者进行了比较。
2004 年 1 月 1 日至 2019 年 12 月 31 日，我院共收治 405 例连续食管或 EGJ 癌患者，包括食管癌切除术。收集的数据包括人口统计学信息、肿瘤分期、术前 Charlson 合并症指数评分、治疗变量以及短期和长期结果。70 岁或以上的患者被归类为“老年”组，70 岁以下的患者为“年轻”组。
188 名年轻（平均年龄 59 岁）和 94 名老年（平均年龄 74 岁）患者接受新辅助放化疗和手术切除治疗 II 期及以上癌症。老年组的术前美国麻醉医师协会和 Charlson 合并症指数评分明显更差。老年组术后心房颤动和尿潴留的发生率更高。尽管如此，3 级及以上术后 Clavien-Dindo 并发症严重程度评分、围手术期死亡率和住院时间相似。70 岁及以上组的 5 年年龄调整生存率为 44.8%，70 岁以下组为 39%（无统计学意义）。
70 岁及以上局部晚期食管或 EGJ 癌患者应评估包括新辅助放化疗和手术切除在内的最佳根治性治疗。尽管老年组术前风险评分和术后房性心律失常较高，但这些患者的短期和长期结果并无差异。
