Key result
Minimally invasive esophagectomy carries similar 90-day mortality risk for patients aged ≥76 versus 71-75.
Why the study?
Elderly patients undergoing gastrointestinal surgery have higher postoperative risks, but literature on esophagectomy in the elderly is inconclusive and pre-dates widespread minimally invasive techniques.
Does age ≥76 years compared to 71-75 years increase morbidity and mortality in patients undergoing minimally invasive esophagectomy?
Cohort (n=187)
No
Does age ≥76 years compared to 71-75 years increase morbidity and mortality in patients undergoing minimally invasive esophagectomy?
Absolute Event Rate: 10.5% vs 4.9%
p-value: p=0.415
Minimally invasive esophagectomy is safe in elderly patients aged ≥76 years, with morbidity and mortality rates comparable to those in younger elderly patients (71-75 years).
Supports safety in selected patients ≥76 years; extends observational data but leaves open need for prospective validation.
Background: Elderly patients undergoing gastrointestinal surgery run a higher risk of postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates from the time before minimally invasive techniques were widely implemented. Methods: Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older were compared to patients aged 71 to 75 years old. Results: A total of 187 patients underwent MIE. Nineteen patients aged 76 years or older (group 1) were compared to 41 patients aged 71 to 75 years (group 2). Median age was 77 years (76–83 years) in group 1 and 72 years (71–75 years) in group 2 (P<0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiation, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The anastomotic leakage rate was 21.1% in group 1 and 14.6% in group 2 (P=0.535). Mortality rate was 10.5% and 4.9% respectively (P=0.415). Conclusions: No significant difference was seen in morbidity and mortality after MIE comparing the eldest to younger old patients. Therefore, patient selection should not be based on calendar age alone.
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Hol et al. (2019) conducted a cohort in Esophageal cancer requiring esophagectomy (n=187). Age ≥76 years vs. Age 71-75 years was evaluated on 90-day mortality (p=0.415). In patients undergoing minimally invasive esophagectomy, 90-day mortality was not significantly different between patients aged ≥76 years and those aged 71-75 years (10.5% vs 4.9%, P=0.415).
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