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Effects of Neoadjuvant Therapy on Perioperative Morbidity in Elderly Patients Undergoing Esophagectomy for Esophageal Cancer

Annals of Surgical Oncology volume 14, pages 3243–3250 (2007)Cite this article

Abstract

Background

The use of cytoreductive therapy followed by surgery is preferred by many centers dealing with locally advanced esophageal cancer. However, the potential for increase in mortality and morbidity rates has raised concerns on the use of chemoradiation therapy, especially in elderly patients. The aim of this study was to assess the effects of induction therapy on postoperative mortality and morbidity in elderly patients undergoing esophagectomy for locally advanced esophageal cancer at a single institution.

Methods

Postoperative mortality and morbidity of patients ≥70 years old undergoing esophagectomy after neoadjuvant therapy, between January 1992 and October 2005 for cancer of the esophagus or esophagogastric junction, were compared with findings in younger patients also receiving preoperative cytoreductive treatments.

Results

818 patients underwent esophagectomy during the study period. The study population included 238 patients <70 years and 31 ≥70 years old undergoing esophageal resection after neoadjuvant treatment. Despite a significant difference in comorbidities (pulmonary, cardiological and vascular), postoperative mortality and morbidity were similar irrespective of age.

Conclusions

Elderly patients receiving neoadjuvant therapies for cancer of the esophagus or esophagogastric junction do not have a significantly increased prevalence of mortality and major postoperative complications, although cardiovascular complications are more likely to occur. Advanced age should no longer be considered a contraindication to preoperative chemoradiation therapy preceding esophageal resection in carefully selected fit patients.

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Affiliations

  1. Istituto Oncologico Veneto (IOV-IRCCS), Clinica Chirurgica III, University of Padova School of Medicine, Padova, Italy

    Giuseppe Portale MD, Carlo Castoro MD, FACS, Matteo Cagol MD, Francesco Cavallin PhD, Vanna Chiarion Sileni MD & Ermanno Ancona MD, FACS

  2. Department of Gastroenterological and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128, Padova, Italy

    Alberto Ruol MD, FACS, Stefano Merigliano MD, Sabrina Rampado & Mario Costantini MD

  3. Istituto Oncologico Veneto (IOV-IRCCS), Radiotherapy, University of Padova, School of Medicine, Padova, Italy

    Luigi Corti MD

Authors
  1. Alberto Ruol MD, FACS
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  2. Giuseppe Portale MD
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  3. Carlo Castoro MD, FACS
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  4. Stefano Merigliano MD
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  5. Matteo Cagol MD
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  6. Francesco Cavallin PhD
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  7. Vanna Chiarion Sileni MD
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  8. Luigi Corti MD
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  9. Sabrina Rampado
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  10. Mario Costantini MD
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  11. Ermanno Ancona MD, FACS
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Corresponding author

Correspondence to Carlo Castoro MD, FACS.

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Ruol, A., Portale, G., Castoro, C. et al. Effects of Neoadjuvant Therapy on Perioperative Morbidity in Elderly Patients Undergoing Esophagectomy for Esophageal Cancer. Ann Surg Oncol 14, 3243–3250 (2007). https://doi.org/10.1245/s10434-007-9455-z

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  • DOI: https://doi.org/10.1245/s10434-007-9455-z

Keywords

  • Esophageal cancer
  • Esophagectomy
  • Neoadjuvant therapy
  • Elderly patients
  • Morbidity
  • Mortality
  • Survival