Abstract
Purpose
A multidisciplinary treatment strategy for locally advanced esophageal squamous cell carcinoma (ESCC) is required to achieve prolonged survival. We aimed to clarify the differences in treatment strategies for locally advanced ESCC and the outcomes of elderly (aged ≥ 75 years) vs. younger patients (aged < 75 years).
Methods
We compared the treatment strategy selection and the outcomes of 40 elderly and 160 younger patients with cStage II/III ESCC diagnosed between January, 2014 and December, 2016.
Results
Nineteen (47.5%) of the elderly patients and 144 (90.0%) of the younger patients underwent esophagectomy and 9 (22.5%) of the elderly patients and 131 (81.9%) of the younger patients received neoadjuvant chemotherapy. Ivor–Lewis or transhiatal esophagectomy was performed more frequently in the elderly group than in the younger group (P = 0.0096). The survival rate after esophagectomy was higher in the younger group than in the elderly group. The overall survival rate of the elderly patients who underwent esophagectomy was significantly higher than that in those who did not.
Conclusions
Esophagectomy is a practical choice for elderly patients with locally advanced ESCC, although reduced treatment intensity may impact long-term survival.
Similar content being viewed by others
References
Center of cancer control and information services NCC: cancer statistics in Japan, cancer infromation service. https://ganjoho.jp/en/professional/statistics/table_download.html
Watanabe M. Recent topics and perspectives on esophageal cancer in Japan. JMA J. 2018;1:30–9.
Ruol A, Portale G, Zaninotto G, Cagol M, Cavallin F, Castoro C, et al. Results of esophagectomy for esophageal cancer in elderly patients: age has little influence on outcome and survival. J Thorac Cardiovasc Surg. 2007;133:1186–92.
Zehetner J, Lipham JC, Ayazi S, Banki F, Oezcelik A, DeMeester SR, et al. Esophagectomy for cancer in octogenarians. Dis Esophagus. 2010;23:666–9.
Morita M, Egashira A, Yoshida R, Ikeda K, Ogaki K, Shibahara K, et al. Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus. J Gastroenterol. 2008;43:345–51.
Poon RT, Law SY, Chu KM, Branicki FJ, Wong J. Esophagectomy for carcinoma of the esophagus in the elderly: Results of current surgical management. Ann Surg. 1998;227:357–64.
Chang AC, Lee JS. Resection for esophageal cancer in the elderly. Thorac Surg Clin. 2009;19:333–43.
Abunasra H, Lewis S, Beggs L, Duffy J, Beggs D, Morgan E. Predictors of operative death after oesophagectomy for carcinoma. Br J Surg. 2005;92:1029–33.
Takeuchi S, Ohtsu A, Doi T, Kojima T, Minashi K, Mera K, et al. A retrospective study of definitive chemoradiotherapy for elderly patients with esophageal cancer. Am J Clin Oncol. 2007;30:607–11.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th Edition: part I. Esophagus. 2017;14:1–36.
Kitagawa Y, Uno T, Oyama T, Kato K, Kato H, Kawakubo H, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus. 2019;16:1–24.
Backemar L, Lagergren P, Johar A, Lagergren J. Impact of co-morbidity on mortality after oesophageal cancer surgery. Br J Surg. 2015;102:1097–105.
Miyazaki T, Tanaka N, Hirai H, Yokobori T, Sano A, Sakai M, et al. Ghrelin level and body weight loss after esophagectomy for esophageal cancer. J Surg Res. 2012;176:74–8.
Elliott J, Jackson S, King S, McHugh R, Docherty GN, Reynolds JV, et al. Gut hormone suppression increases food intake after esopagectomy with gastric conduit reconstruction. Ann Surg. 2015;262:824–9.
Nakamura M, Nakamori M, Ojima T, Katsuda M, Hayata K, Iwahashi M, et al. The effect of rikkunshito on body weight loss after esophagectomy. J Surg Res. 2016;204:130–8.
Kato H, Miyazaki T, Sakai M, Sano A, Tanaka N, Kimura H, et al. Videofluoroscopic evaluation in oropharyngeal swallowing after radical esophagectomy with lymphadenectomy for esophageal cancer. Anticancer Res. 2007;27:4249–54.
Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol. 2010;16:3804–10.
Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for locally advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.
Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, et al. Perioperative outcomes of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. Dis Esophagus. 2017;30:1–8.
Funding
Funding information is not available.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest to declare in association with this manuscript.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Human rights
This study protocol was approved by the JFCR ethics committee.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Kozuki, R., Watanabe, M., Toihata, T. et al. Treatment strategies and outcomes for elderly patients with locally advanced squamous cell carcinoma of the esophagus. Surg Today 52, 377–384 (2022). https://doi.org/10.1007/s00595-021-02348-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-021-02348-9