Therapeutic management of elderly patients with esophageal cancer

Background. In an aging population, it is important to evaluate the therapeutic management of diseases. Esophagectomy is a reliable treatment for esophageal cancer, but it remains controversial for elderly patients as it could carry additional postoperative risks. Methods. Between April 1994 and March 2004, 418 patients with esophageal cancer were registered at our hospital. Clinicopathological factors and therapeutic outcomes for 65 patients aged over 75 years (elderly patients) and 353 patients aged under 75 years (nonelderly patients) were compared retrospectively. Results. In total, 19 patients aged over 75 years and 203 patients aged under 75 years underwent resection. The elderly patients were characterized by short operation times, surgery by transhiatal approach, organ reconstruction using the jejunum, fewer lymph nodes removed, and frequent comorbid disease. Curative resections were performed in 16 elderly patients (84.2%) and 173 nonelderly patients (85.2%). Postoperative morbidity did not differ between the two groups, but hospital death was more frequent in elderly patients. The overall survival time was significantly higher for nonelderly patients. However, the disease-specific survival did not differ between the two groups. Nonsurgical treatments were administered to 46 elderly patients and 150 nonelderly patients; no significant difference in survival was observed between the two groups. The overall survival times were not different between surgical treatment and nonsurgical treatment in the elderly group. Conclusions. Elderly patients obtained similar therapeutic benefits from esophagectomy as did nonelderly patients through careful management of comorbid disease and good perioperative care. Also, nonsurgical treatment is a useful treatment option for elderly patients. A well-designed randomized trial, of surgical versus nonsurgical treatment, should be conducted in the elderly to clarify this concern. © 2008 Japan Esophageal Society and Springer.