Esophageal cancer in octogenarians: Should esophagectomy be done?

Impact of preoperative comorbidities on elderly patients with esophageal squamous cell carcinoma following esophagectomy: a propensity score matching analysis

OBJECTIVE

Elderly patients, particularly those aged 70 and above, often present with comorbidities such as coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and high blood pressure (HBP). These comorbid diseases complicate treatment. However, the impact of these comorbidities on survival outcomes and complications in elderly patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) remains under-researched.

METHODS

This cohort study examined ESCC patients aged 70 and older who underwent esophagectomy. Patients were divided into two cohorts: those without preoperative comorbid diseases (NCD group) and those with preoperative comorbid diseases (CD group). Data were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database between May 2016 and August 2021, with follow-up concluding on December 20, 2023.

RESULTS

A total of 469 patients met the inclusion criteria, with 206 patients in the comorbid diseases (CD group) and 263 patients without (NCD group). The median follow-up period was 47.5 months, the median overall survival (OS) was 51.6 months and median disease-free survival (DFS) was 33.0 months, with no statistically significant difference in OS and DFS in 2 groups. The incidence of grade 3 or higher complications in the NCD and CD groups was similar, with no statistically significant difference. The most common grade 3 or higher complications were pulmonary infection, hydrothorax, anastomotic stenosis, and anastomotic leakage.

CONCLUSIONS

Preoperative comorbidities, including CHD, COPD, DM, and HBP, did not significantly impact the long-term survival or disease-free survival of elderly ESCC patients undergoing esophagectomy.

Esophagectomy in the Older Adult: A Systematic Review

Current management of esophageal carcinoma (EC) involves combining different modalities, offering the opportunity of personalized strategies. This is particularly enticing in the geriatric population, where tailoring treatment modalities remains key to achieve good outcomes in terms of both quality of life and survival. Primary outcomes of our review included (1) evidence on short-term outcomes following esophagectomy, and (2) evidence on long-term outcomes following esophagectomy. Secondary review questions compared outcomes of (1) neoadjuvant treatment versus upfront surgery for locally advanced esophageal carcinoma, (2) endoscopic submucosal dissection versus esophagectomy for early esophageal carcinoma, and (3) definitive radiation with or without chemotherapy versus surgery. Twenty-six articles were included in the review for the main review questions. Our systematic review underscores the need for comprehensive geriatric evaluations to guide decision-making. Despite concerns about perioperative risks, well-selected older patients can derive survival benefits from surgical intervention.