Department of Geriatric Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel..
Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
J Geriatr Oncol. 2024 Mar;15(2):101710. doi: 10.1016/j.jgo.2024.101710. Epub 2024 Jan 28.
Esophagectomy is the treatment of choice for esophageal cancer. In octogenarians data is conflicting. We evaluated postoperative outcomes and long-term survival of octogenarians and their younger counterparts.
A retrospective analysis of a prospectively maintained database including consecutive patients with esophageal cancer who underwent esophagectomy at a large referral, academic center between 2012 and 2021. Subgroups were designed according to age (<70, 70-79, and ≥ 80).
A total of 359 patients underwent esophagectomy for esophageal cancer, 223 (62%) aged <70, 107 (30%) aged 70-79 and 29 (8%) aged ≥80. Octogenarians had higher American Society of Anesthesiologists [ASA] scores (p = 0.001), and fewer received neoadjuvant therapy (p = 0.04). Octogenarians experienced more major complications (P < 0.001) with significantly higher 30-day mortality rate (P = 0.001). In a multivariable analysis, major complications were associated with higher risk of being discharged to a rehabilitation center (odds ratio [OR] 14.839, 95% confidence interval [CI] 4.921-44.747, p < 0.001) while age was not. Overall survival was reduced in octogenarians, with a 50th percentile survival of 10 months compared to 32 and 26 months in patients age < 70 and 70-79, respectively (p = 0.014). In a multivariable analysis, age ≥ 80 (hazard ratio [HR] 4.478 95% CI 2.151-9.322, p < 0.001), cancer stage (HR 1.545, 95% CI 1.095-2.179, p = 0.013), and postoperative major complications (HR 2.705 95% CI 1.913-3.823, p < 0.001) were independently associated with reduced survival.
Our study showed that octogenarians had significantly higher postoperative major complications compared to younger age groups. Overall survival was significantly reduced in these patients, probably due to an increased rate of perioperative mortality. Better patient selection and preparation may improve postoperative outcomes and increase long-term survival.
食管癌的治疗方法是手术切除。八十岁以上老年人的数据存在矛盾。我们评估了高龄患者（≥ 80 岁）和较年轻患者（<70 岁和 70-79 岁）的术后结果和长期生存率。
对 2012 年至 2021 年期间在一家大型转诊学术中心接受食管癌手术的连续患者的前瞻性维护数据库进行回顾性分析。根据年龄（<70、70-79 和≥80）设计亚组。
共 359 例患者接受食管癌手术，其中 223 例（62%）年龄<70 岁，107 例（30%）年龄 70-79 岁，29 例（8%）年龄≥80 岁。八十岁以上老年人的美国麻醉医师协会（ASA）评分更高（p=0.001），接受新辅助治疗的比例较低（p=0.04）。八十岁以上老年人发生严重并发症的比例更高（P<0.001），30 天死亡率显著升高（P=0.001）。多变量分析显示，严重并发症与更高的康复中心出院风险相关（比值比[OR] 14.839，95%置信区间[CI] 4.921-44.747，p<0.001），而年龄则没有。八十岁以上老年人的总体生存率降低，50%的生存率为 10 个月，而年龄<70 岁和 70-79 岁的患者分别为 32 个月和 26 个月（p=0.014）。多变量分析显示，年龄≥80 岁（危险比[HR] 4.478，95%CI 2.151-9.322，p<0.001）、癌症分期（HR 1.545，95%CI 1.095-2.179，p=0.013）和术后严重并发症（HR 2.705，95%CI 1.913-3.823，p<0.001）与生存率降低独立相关。
我们的研究表明，八十岁以上老年人与年轻患者组相比，术后严重并发症发生率显著升高。这些患者的总体生存率显著降低，可能是由于围手术期死亡率增加所致。更好的患者选择和准备可能会改善术后结果并提高长期生存率。
