Kim Ji Yong, Yun Jae Kwang, Kim Hyeong Ryul, Park Seung-Il, Kim Yong-Hee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur J Surg Oncol. 2025 Mar;51(3):109542. doi: 10.1016/j.ejso.2024.109542. Epub 2024 Dec 10.
With the global aging, the number of elderly candidates for esophageal resection is increasing. However, studies on esophagectomy in elderly patients have yielded conflicting results, and individuals over 75 years old are frequently excluded from studies on esophageal cancer. This study aimed to analyze perioperative and survival outcomes post-esophagectomy in elderly patients using propensity score matching (PSM).
Patients with esophageal carcinoma who underwent esophagectomy (2006-2020) were studied. A 1:2 PSM was performed, with matching variables, including operational approach, type of operation, Charlson Comorbidity Index without age score, clinical stage, and treatment modality. Perioperative and survival outcomes were compared between the age groups.
After PSM, 91 elderly and 182 non-elderly patients were analyzed. The postoperative in-hospital mortality rate was identical for both groups at 1.1 %. The non-elderly group had a significantly higher 4-week discharge rate (91.8 % vs. 84.6 %, p = 0.032). There were no significant differences in overall postoperative complications (p = 0.886). Grade III-IV complications occurred in 16.5 % of elderly and 8.8 % of non-elderly patients, with no significant difference (p = 0.092). The 5-year overall survival rate was significantly lower in the elderly group (47.3 % vs. 69.8 %, p = 0.022), while the 5-year recurrence-free survival rate showed no significant difference (45.7 % vs. 63.6 %, p = 0.119).
Elderly patients undergoing esophagectomy were similar to non-elderly patients in overall complications and in-hospital mortality. Despite a tendency for increased severity of complications and a significantly lower 4-week discharge rate, esophagectomy remains acceptable for elderly patients.
随着全球老龄化，老年食管癌切除候选患者数量不断增加。然而，关于老年患者食管癌切除术的研究结果相互矛盾，75岁以上个体经常被排除在食管癌研究之外。本研究旨在使用倾向评分匹配（PSM）分析老年患者食管癌切除术后的围手术期和生存结果。
对2006年至2020年接受食管癌切除术的患者进行研究。进行1:2的PSM，匹配变量包括手术方式、手术类型、不包括年龄评分的Charlson合并症指数、临床分期和治疗方式。比较各年龄组的围手术期和生存结果。
PSM后，分析了91例老年患者和182例非老年患者。两组术后住院死亡率相同，均为1.1%。非老年组4周出院率显著更高（91.8%对84.6%，p = 0.032）。术后总体并发症无显著差异（p = 0.886）。16.5%的老年患者和8.8%的非老年患者发生III-IV级并发症，无显著差异（p = 0.092）。老年组5年总生存率显著更低（47.3%对69.8%，p = 0.022），而5年无复发生存率无显著差异（45.7%对63.6%，p = 0.119）。
接受食管癌切除术的老年患者在总体并发症和住院死亡率方面与非老年患者相似。尽管并发症严重程度有增加趋势且4周出院率显著更低，但食管癌切除术对老年患者仍是可接受的。
