Favorable Surgery Outcomes for Older Patients with Esophageal Cancer

Patients aged more than 70 years had comparable outcomes to younger patients following surgery for esophageal cancer, according to a new study.

Esophagectomy, or the resection of part or all of the esophagus, is a recommended therapy for esophageal or esophagogastric cancer that is often not offered to elderly patients due to fear of surgical complications, according to the researchers.

“Multiple studies have documented low utilization of esophagectomy in elderly patient populations with potentially curable esophageal or esophagogastric cancer despite current guidelines, which recommend curative-intent NACR followed by surgical resection,” wrote the study authors.

For this study, investigators assessed outcomes for 282 patients who received neoadjuvant chemotherapy prior to undergoing esophagectomy with curative intent between 2004 and 2019. Patients were stratified according to age. Overall, the cohort comprised 188 patients aged less than 70 years and 94 patients aged more than 70 years.

Following surgery, atrial fibrillation and urinary retention were more common among the older group of patients. Despite this, rates of postoperative complication severity, perioperative mortality, and lengths of stay were similar between older and younger patients. Five-year age-adjusted survival was 44.8% among older patients, compared with 39% for young patients.

“Even though our results are not randomized, these findings provide a strong indication that declining to perform a surgical resection significantly reduces the likelihood of a cure for older patients who are deemed fit for the operation,” said co-author John S. Bolton, MD, surgical oncologist at the Ochsner Clinic Foundation, in a press release.

“Patients 70 years and older with locally advanced esophageal or esophagogastric junction cancer should be evaluated for optimal curative therapy including neoadjuvant chemoradiotherapy and surgical resection. Although preoperative risk scoring and postoperative atrial arrhythmias are higher in the older group, short- and long-term outcomes are not inferior in these patients,” the authors concluded.

The findings of this study were published in the Journal of the American College of Surgeons.