Esophageal resection in elderly esophageal carcinoma patients: Improvement in postoperative complications

Background. Advanced age is considered to be a relative contraindication for radical esophagectomy with a three-field lymph node dissection. Methods. Preoperative risks, postoperative morbidity and mortality, and long-term survival in 55 elderly patients (greater than or equal to 70 years) who had undergone extensive esophagectomy for esophageal carcinoma were compared with those of 149 younger patients (<70 years). Results. Elderly patients had worse preoperative cardiopulmonary function and had more frequent postoperative cardiopulmonary complications compared with younger patients (p < 0.05). The postoperative death rate was not statistically different between the elderly (10.9%) and younger groups (5.4%). When the study period was divided into an early and a late phase, the postoperative death rate dropped significantly (p < 0.05) in recent years (1.4%) when compared with the previous era (10.0%). The overall survival rates were not different between elderly and younger patients. Conclusions. Preoperative cardiopulmonary risk factors and postoperative complications after esophagectomy were more frequently noticed in elderly patients than in younger patients. A dramatic improvement in postoperative death was noticed in recent years. The long-term survival of elderly patients after extended esophagectomy was almost similar to that in younger patients. (C) 2001 by The Society of Thoracic Surgeons.