• Annals of surgery · Jul 2022

    Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5,066 Patients in the National Database of Hospital-Based Cancer Registries in Japan.

    • Satoru Motoyama, Eri Maeda, Katsunori Iijima, Yusuke Sato, Shigeto Koizumi, Akiyuki Wakita, Yushi Nagaki, Hiromu Fujita, Takatoshi Yoneya, Kazuhiro Imai, Kaori Terata, Yoshihiro Minamiya, and Takahiro Higashi.
    • Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.
    • Ann. Surg. 2022 Jul 1; 276 (1): e16-e23.

    ObjectiveTo determine whether esophagectomy provides a survival advantage in octogenarians with resectable thoracic esophageal cancer.Summary Background DataElderly patients with thoracic esophageal cancer do not always receive the full standard treatment; however, advanced age alone should not preclude the use of effective treatment that could meaningfully improve survival.MethodsWe retrieved the 2008 to 2011 data from the National Database of Hospital-based Cancer Registries from the National Cancer Centerin Japan, divided the patients into a ≥75 group (75-79 years; n = 2935) and a ≥80 group (80 years or older; n = 2131), and then compared the patient backgrounds and survival curves. A multivariable Cox proportional hazards regression model was developed to compare the effects of esophagectomy and chemoradiotherapy in the 2 groups.ResultsA significantly greater percentage of patients were treated with esoph-agectomy in the ≥75 group (34.6%) than the ≥80 group (18.4%). Among patients who received esophagectomy, the 3-year survival rate was 51.1% in the ≥ 75 group and 39.0% in the ≥80 group (P < 0.001). However, among patients who received chemoradiotherapy, there was no difference in survival curve between the 2 groups (P = 0.17). Multivariable Cox proportional hazard analysis revealed that esoph-agectomy for clinical Stage ii-iii patients was significantly associated to better survival (adjusted HR: 0.731) (95%CI: 0.645-0.829, P < 0.001) in the ≥75 group but not the ≥ 80 group when compared with chemoradiotherapy.ConclusionsMany octogenarians do not necessarily get a survival benefit from esophagectomy. However, patients should be evaluated based on their overall health before ruling out surgery based on age alone.Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.

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