Long-term Outcomes Following Esophagectomy in Older and Younger Adults with Esophageal Cancer.
Esophagectomy
Older adults
Outcomes
Recurrence
Survival
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
18
01
2022
accepted:
02
03
2022
pubmed:
1
4
2022
medline:
14
6
2022
entrez:
31
3
2022
Statut:
ppublish
Résumé
Patterns of overall and disease-free survival after esophagectomy for esophageal cancer in older adults have not been carefully studied. Retrospective analysis of all patients with esophageal cancer undergoing esophagectomy from 2005 to 2020 at our institution was performed. Differences in outcomes were stratified by age groups, < 75 and ≥ 75 years old, and two time periods, 2005-2012 and 2013-2020. A total of 1135 patients were included: 979 (86.3%) patients were < 75 (86.3%), and 156 (13.7%) were ≥ 75 years old. Younger patients had fewer comorbidities, better nutritional status, and were more likely to receive neoadjuvant and adjuvant therapy (all p < 0.05). However, tumor stage and operative approach were similar, except for increased performance of the McKeown technique in younger patients (p = 0.02). Perioperatively, younger patients experienced fewer overall and grade II complications (both p < 0.05). They had better overall survival (log-rank p-value < 0.001) and median survival, 62.2 vs. 21.5 months (p < 0.05). When stratified by pathologic stage, survival was similar for yp0 and pathologic stage II disease (both log-rank p-value > 0.05). Multivariable Cox models showed older age (≥ 75 years old) had increased hazard for reduced overall survival (HR 2.04 95% CI 1.5-2.8; p < 0.001) but not disease-free survival (HR 1.1 95% CI 0.78-1.6; p = 0.54). Over time, baseline characteristics remained largely similar, while stage became more advanced with a rise in neoadjuvant use and increased performance of minimally invasive esophagectomy (all p < 0.05). While overall complication rates improved (p < 0.05), overall and recurrence-free survival did not. Overall survival was better in younger patients during both time periods (both log-rank p < 0.05). Despite similar disease-free survival rates, long-term survival was decreased in older adults as compared to younger patients. This may be related to unmeasured factors including frailty, long-term complications after surgery, and competing causes of death. However, our results suggest that survival is similar in those with complete pathologic responses.
Sections du résumé
BACKGROUND
Patterns of overall and disease-free survival after esophagectomy for esophageal cancer in older adults have not been carefully studied.
METHODS
Retrospective analysis of all patients with esophageal cancer undergoing esophagectomy from 2005 to 2020 at our institution was performed. Differences in outcomes were stratified by age groups, < 75 and ≥ 75 years old, and two time periods, 2005-2012 and 2013-2020.
RESULTS
A total of 1135 patients were included: 979 (86.3%) patients were < 75 (86.3%), and 156 (13.7%) were ≥ 75 years old. Younger patients had fewer comorbidities, better nutritional status, and were more likely to receive neoadjuvant and adjuvant therapy (all p < 0.05). However, tumor stage and operative approach were similar, except for increased performance of the McKeown technique in younger patients (p = 0.02). Perioperatively, younger patients experienced fewer overall and grade II complications (both p < 0.05). They had better overall survival (log-rank p-value < 0.001) and median survival, 62.2 vs. 21.5 months (p < 0.05). When stratified by pathologic stage, survival was similar for yp0 and pathologic stage II disease (both log-rank p-value > 0.05). Multivariable Cox models showed older age (≥ 75 years old) had increased hazard for reduced overall survival (HR 2.04 95% CI 1.5-2.8; p < 0.001) but not disease-free survival (HR 1.1 95% CI 0.78-1.6; p = 0.54). Over time, baseline characteristics remained largely similar, while stage became more advanced with a rise in neoadjuvant use and increased performance of minimally invasive esophagectomy (all p < 0.05). While overall complication rates improved (p < 0.05), overall and recurrence-free survival did not. Overall survival was better in younger patients during both time periods (both log-rank p < 0.05).
CONCLUSIONS
Despite similar disease-free survival rates, long-term survival was decreased in older adults as compared to younger patients. This may be related to unmeasured factors including frailty, long-term complications after surgery, and competing causes of death. However, our results suggest that survival is similar in those with complete pathologic responses.
Identifiants
pubmed: 35357674
doi: 10.1007/s11605-022-05295-z
pii: 10.1007/s11605-022-05295-z
pmc: PMC9474270
mid: NIHMS1832470
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1119-1131Subventions
Organisme : NIA NIH HHS
ID : T32 AG023480
Pays : United States
Organisme : NIA NIH HHS
ID : T32AG023480
Pays : United States
Informations de copyright
© 2022. The Society for Surgery of the Alimentary Tract.
Références
Ann Thorac Surg. 2010 Sep;90(3):900-7
pubmed: 20732515
Anticancer Res. 2013 Apr;33(4):1641-7
pubmed: 23564809
Eur J Surg Oncol. 2021 Oct;47(10):2667-2674
pubmed: 33895020
J Am Geriatr Soc. 2020 Sep;68(9):1941-1946
pubmed: 32662064
J Surg Res. 2018 Sep;229:9-14
pubmed: 29937021
Ann Thorac Surg. 2021 Mar;111(3):996-1003
pubmed: 32853569
Ann Cardiothorac Surg. 2017 Mar;6(2):119-130
pubmed: 28447000
J Gastrointest Cancer. 2020 Sep;51(3):893-900
pubmed: 31701400
Ann Cardiothorac Surg. 2017 Mar;6(2):175-178
pubmed: 28447007
Chest Surg Clin N Am. 2000 Aug;10(3):531-52
pubmed: 10967755
N Engl J Med. 2012 May 31;366(22):2074-84
pubmed: 22646630
Surg Endosc. 2022 Feb;36(2):1332-1338
pubmed: 33660122
Thorac Surg Clin. 2009 Aug;19(3):333-43
pubmed: 20066945
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Ann Thorac Surg. 2013 May;95(5):1741-8
pubmed: 23500043
BMC Surg. 2019 Oct 15;19(1):143
pubmed: 31615499
J Clin Oncol. 2020 Aug 1;38(22):2558-2569
pubmed: 32250717
J Clin Oncol. 2018 Aug 1;36(22):2326-2347
pubmed: 29782209