• Nikolaj S Baranov, Frans van Workum, Jolijn van der Maas, Ewout Kouwenhoven, Marc van Det, van den WildenbergFrits J HFJHDepartment of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Fatih Polat, NieuwenhuijzenGrard A PGAPDepartment of Surgery, Catharina Hospital, Eindhoven, The Netherlands., LuyerMisha D PMDPDepartment of Surgery, Catharina Hospital, Eindhoven, The Netherlands., and Camiel Rosman.
• Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. nikolaj.baranov@radboudumc.nl.
• J. Gastrointest. Surg. 2019 Jul 1; 23 (7): 1293-1300.

BackgroundThe number of elderly patients suffering from esophageal cancer is increasing, due to an increasing incidence of esophageal cancer and increasing life expectancy. However, the effect of age on morbidity, mortality, and survival after Ivor Lewis total minimally invasive esophagectomy (TMIE) is not well known.MethodsA prospectively documented database from December 2010 to June 2017 was analyzed, including all patients who underwent Ivor Lewis TMIE for esophageal cancer in three Dutch high-volume esophageal cancer centers. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Baseline patient characteristics and perioperative data were included. Surgical complications were graded using the Clavien-Dindo scale. The primary outcome was postoperative complications Clavien-Dindo ≥ 3. Secondary outcome parameters were postoperative complications, in-hospital mortality, 30- and 90-day mortality and survival.ResultsFour hundred and forty-six patients were included, 357 in the younger and 89 in the elderly group. No significant differences were recorded regarding baseline patient characteristics. There was no significant difference in complications graded Clavien-Dindo ≥ 3 and overall complications, short-term mortality, and survival. Delirium occurred in 27.0% in the elderly and 11.8% in the younger group (p < 0.001). After correction for baseline comorbidity this difference remained significant (p = 0.001). Median hospital length of stay was 13 days in the elderly and 11 days in the younger group (p = 0.010).ConclusionsIvor Lewis TMIE can be safely performed in selected elderly patients without increasing postoperative morbidity and mortality.

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