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Esophageal Cancer in the Elderly

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Principles and Practice of Geriatric Surgery

Abstract

Neoplasms of the esophagus and gastroesophageal junction are aggressive tumors that often present at an advanced stage and that historically have been associated with poor survival despite therapy. Surveillance, Epidemiology and End Results (SEER) data from the National Cancer Institute estimate that 16,470 Americans are diagnosed with and 14,280 die of esophageal cancer annually. Moreover, the incidence of esophageal cancer is increasing, with an annual percentage change of +0.5% between 1975 and 2005. SEER data also demonstrate that esophageal cancer is primarily a disease of the elderly. From 2001 to 2005, the median age at diagnosis for cancer of the esophagus was 69 years, with 61.5% of those diagnosed being age 65 or older (Fig. 60.1) [1]. According to US Census Bureau projections, we can expect our population to be older by midcentury. In 2000, 12% of the population was 65 or older. In 2030, when all of the baby boomers will be 65 or older, this age group will represent 20% of the US population. This age group is projected to increase to 88.5 million in 2050, more than doubling the number in 2008 (38.7 million) [2].

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References

  1. Surveillance, Epidemiology and End Results (2008) http://seer.cancer.gov/statfacts/html/esoph.html. Accessed 2 Nov 2008

  2. U.S. Census Bureau (2008) http://www.census.gov/Press-Release/www/releases/archives/population/012496.html. Accessed 2 Nov 2008

  3. Pohl H, Welch G (2005) The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 97:142–146

    Article  PubMed  Google Scholar 

  4. Postlethwaite RW (1986) Squamous cell carcinoma of the esophagus. In: Postlethwaite RW (ed) Surgery of the esophagus, 2nd edn. Appleton & Lange, Norwalk, CT, pp 369–442

    Google Scholar 

  5. Ming S (1992) Adenocarcinoma and other epithelial tumors of the esophagus. In: Ming S, Goldman H (eds) Pathology of the gastrointestinal tract. Saunders, Philadelphia, pp 459–477

    Google Scholar 

  6. Ibrahim NB, Briggs JC, Corbishley CM (1984) Extrapulmonary oat cell carcinoma. Cancer 54:1645–1661

    Article  PubMed  CAS  Google Scholar 

  7. Enzinger C, Mayer J (2003) Esophageal cancer. N Engl J Med 349:2241–2252

    Article  PubMed  CAS  Google Scholar 

  8. Newcomb PA, Carbone PP (1992) The health consequences of smoking. Med Clin North Am 76:305–331

    PubMed  CAS  Google Scholar 

  9. Choi SY, Kahyo H (1991) Effect of cigarette smoking and alcohol consumption in the etiology of cancers of the digestive tract. Int J Cancer 49:381–386

    Article  PubMed  CAS  Google Scholar 

  10. Francheschi S, Talamini R, Barra S et al (1990) Smoking and drinking in relation to cancers of the oral cavity, pharynx, and esophagus in northern Italy. Cancer Res 50:6502–6507

    Google Scholar 

  11. DeStefani E, Munoz N, Esteve J et al (1990) Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay. Cancer Res 50:426–431

    CAS  Google Scholar 

  12. Gray JR, Coldman AJ, MacDonald WC (1992) Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus. Cancer 69:2227–2231

    Article  PubMed  CAS  Google Scholar 

  13. Christen AG, McDonald JL Jr, Olsen BL, Christen JA (1989) Smokeless tobacco addiction: a threat to the oral and systemic health of the child and adolescent. Pediatrician 16:170–177

    PubMed  CAS  Google Scholar 

  14. Adami HO, McLaughlin JK, Hsing AW et al (1992) Alcoholism and cancer risk: a population-based cohort study. Cancer Causes Control 3:419–425

    Article  PubMed  CAS  Google Scholar 

  15. Kato I, Nomura AM, Stemmermenn GN, Chyon PH (1992) Prospective study of the association of alcohol with cancer of the upper aerodigestive tract and other sites. Cancer Causes Control 3:145–151

    Article  PubMed  CAS  Google Scholar 

  16. Risk JM, Mills HS, Garde J et al (1999) The tylosis esophageal cancer (TOC) locus: more than just a familial cancer gene. Dis Esophagus 12:173–176

    Article  PubMed  CAS  Google Scholar 

  17. Ellis A, Field JK, Field EA et al (1994) Tylosis associated with carcinoma of the oesophagus and oral leukoplakia in a large Liverpool family – a review of six generations. Eur J Cancer B Oral Oncol 30:102–112

    Article  Google Scholar 

  18. Lagergren J, Bergström R, Lindgren A et al (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831

    Article  PubMed  CAS  Google Scholar 

  19. Spechler SJ (2005) Dysplasia in Barrett’s esophagus: limitations of current management strategies. Am J Gastroenterol 100(4):927–935

    Article  PubMed  Google Scholar 

  20. Solaymani-Dodaran M, Logan RF, West J et al (2004) Risk of oesophageal cancer in Barrett’s oesophagus and gastro-oesophageal reflux. Gut 53:1070–1074

    Article  PubMed  CAS  Google Scholar 

  21. Shaheen N, Ransohoff DF (2002) Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: scientific review. JAMA 287:1972–1981

    Article  PubMed  Google Scholar 

  22. Barrett NR (1950) Chronic peptic ulcer of the oesophagus and “oesophagitis”. Br J Surg 38:175–182

    Article  PubMed  CAS  Google Scholar 

  23. Fein R, Kelsen DP, Geller N et al (1985) Adenocarcinoma of the esophagus and gastroesophageal junction: prognostic factors and results of therapy. Cancer 56:2512–2518

    Article  PubMed  CAS  Google Scholar 

  24. Puli SR, Reddy JB, Bechtold ML et al (2008) Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol 14(10):1479–1490

    Article  PubMed  Google Scholar 

  25. Flamen P, Lerut A, Van Cutsem E et al (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18:3202–3210

    PubMed  CAS  Google Scholar 

  26. Swisher SG, Maish M, Erasmus JJ et al (2004) Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg 78:1152–1160

    Article  PubMed  Google Scholar 

  27. Cerfolio RJ, Bryant AS, Buddhiwardhan O et al (2005) The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg 129:1232–1241

    Article  PubMed  Google Scholar 

  28. Krasna MJ, Flowers JL, Attar S et al (1996) Combined thoracoscopic/laparoscopic staging of esophageal cancer. J Thorac Cardiovasc Surg 111:800–806, discussion 806–807

    Article  PubMed  CAS  Google Scholar 

  29. (2010) Esophagus. In: Edge SE, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) AJCC cancer staging manual, 7th edn. Springer, New York, NY

    Google Scholar 

  30. Loran DB, Zwischenberger JB (2004) Thoracic surgery in the elderly. J Am Coll Surg 199(5):773–784

    Article  PubMed  Google Scholar 

  31. Orringer MB, Sloan H (1978) Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg 76:643–654

    PubMed  CAS  Google Scholar 

  32. Lewis I (1946) The surgical treatment of carcinoma of the esophagus with special reference to a new operation for growths of the middle third. Br J Surg 34:18

    Article  PubMed  CAS  Google Scholar 

  33. McKeown KC (1976) Total three-stage esophagectomy for cancer of the esophagus. Br J Surg 51:259–262

    Article  Google Scholar 

  34. Bolten JS, Teng S (2002) Transthoracic or transhiatal esophagectomy for cancer of the esophagus – does it matter. Surg Oncol Clin N Am 11:365–375

    Article  Google Scholar 

  35. Dimick JB, Pronovost PJ, Cowan JA et al (2003) Surgical volume and quality of care for esophageal resection: do high-volume hospitals have fewer complications? Ann Thorac Surg 75:337–341

    Article  PubMed  Google Scholar 

  36. Rizk NP, Bach PB, Schrag D et al (2004) The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 198:42–50

    Article  PubMed  Google Scholar 

  37. Davis PA, Law S, Wong J (2003) Colonic interposition after esophagectomy for cancer. Arch Surg 138:303–308

    Article  PubMed  Google Scholar 

  38. Orringer MB, Marshall B, Iannettoni MD (2000) Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 119:277–288

    Article  PubMed  CAS  Google Scholar 

  39. Marshall OMB, Iannettoni MD B (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–400, discussion 400–403

    Article  PubMed  Google Scholar 

  40. Orringer MB, Marshall B, Chang AC et al (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 246:363–374

    Article  PubMed  Google Scholar 

  41. Altorki N, Kent M, Ferrara C, Port J (2002) Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 236:177–183

    Article  PubMed  Google Scholar 

  42. Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 374:1662–1669

    Article  Google Scholar 

  43. Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72:306–313

    Article  PubMed  CAS  Google Scholar 

  44. Peyre CG, Hagen JA, DeMeester SR et al (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556

    Article  PubMed  Google Scholar 

  45. Heitmiller RF (1992) Results of standard left thoracoabdominal esophagogastrectomy. Semin Thorac Cardiovasc Surg 4:314–319

    PubMed  CAS  Google Scholar 

  46. Luketich JD, Alvelo-Rivera M, Buenaventura PO et al (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494

    PubMed  Google Scholar 

  47. Ruol A, Portale G, Zaninotto G et al (2007) Results of esophagectomy for esophageal cancer in elderly patients: age has little ­influence on outcome and survival. J Thorac Cardiovasc Surg 133:1186–1192

    Article  PubMed  Google Scholar 

  48. Sabel MS, Smith JL, Nava HR et al (2002) Esophageal resection for carcinoma in patients older than 70 years. Ann Surg Oncol 9(2):210–214

    Article  PubMed  Google Scholar 

  49. Moskovitz AH, Rizk NP, Venkatraman E et al (2006) Mortality increases for octogenarians undergoing esophagogastrectomy for esophageal cancer. Ann Thorac Surg 82:2031–2036

    Article  PubMed  Google Scholar 

  50. Bailey SH, Bull DA, Harpole DH et al (2003) Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 75:217–222

    Article  PubMed  Google Scholar 

  51. Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205:729–734

    Article  PubMed  Google Scholar 

  52. Ra J, Paulson EC, Kucharczuk J et al (2008) Postoperative mortality after esophagectomy for cancer: development of a preoperative risk prediction model. Ann Surg Oncol 15(6):1577–1584

    Article  PubMed  Google Scholar 

  53. Arnott SJ, Duncan W, Gignoux M, Girling DJ, Hansen HS, Launois B, Nygaard K, Parmar MKB, Rousell A, Spiliopoulos G, Stewart LA, Tierney JF,Wang M, Rhugang Z (Oeosphageal Cancer Collaborative Group) (2005) Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev (4). Art. No: CD001799. doi: 10.1002/14651858.CD001799.pub2

  54. Kelsen DP, Ginsberg R, Pajak TF et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

    Article  PubMed  CAS  Google Scholar 

  55. Medical Research Council Oesophageal Cancer Working Group (2002) Surgical resection with or without postoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733

    Article  Google Scholar 

  56. Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355(1):11–20

    Article  PubMed  CAS  Google Scholar 

  57. Malthaner RA, Collin S, Fenlon D (2006) Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database Syst Rev (3) Art. No: CD001556. doi: 10.1002/14651858.CD001556.pub2

  58. Walsh T, Noonan N, Hollywood D et al (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335:462–467

    Article  PubMed  CAS  Google Scholar 

  59. Bosset J-F, Gignoux M, Triboulet J-P et al (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337:161–167

    Article  PubMed  CAS  Google Scholar 

  60. Gebski V, Burmeister B, Smithers BM et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:33–34

    Article  Google Scholar 

  61. Rice DC, Correa AM, Vaporciyan AA et al (2005) Preoperative chemoradiotherapy prior to esophagectomy in elderly patients is not associated with increased morbidity. Ann Thorac Surg 79:391–397

    Article  PubMed  Google Scholar 

  62. Orringer MB (1984) Substernal gastric bypass of the excluded esophagus – results of an ill-advised operation. Surgery 96:467–470

    PubMed  CAS  Google Scholar 

  63. Herskovic A, Martz K, Al-Sarraf M et al (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326:1593–1598

    Article  PubMed  CAS  Google Scholar 

  64. Atkinson M, Ferguson R (1997) Fibreoptic endoscopic palliative intubation of inoperable oesophagogastric neoplasms. Br Med J 1:266–267

    Article  Google Scholar 

  65. Cook TA, Dehn CB (1996) Use of covered expandable metal stents in the treatment of oesophageal carcinoma and tracheo-oesophageal fistula. Br J Surg 83:1417–1418

    Article  PubMed  CAS  Google Scholar 

  66. Litle VR, Luketich JD, Christie NA et al (2003) Photodynamic therapy as palliation for esophageal cancer: experience in 215 patients. Ann Thorac Surg 76:1687

    Article  PubMed  Google Scholar 

  67. Heitmiller RF (1994) Cancer of the esophagus. In: Bayless TM (ed) Current therapy in gastroenterology and liver disease, 4th edn. Mosby, St. Louis, pp 81–85

    Google Scholar 

  68. Reichle R, Nixon M, Heitmiller RF, Fishman E (1993) Post surgical evaluation of the esophagus: normal radiographic appearance and complications. Invest Radiol 28:247–257

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Philip A. Rascoe .

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Rascoe, P.A., Kucharczuk, J.C., Kaiser, L.R. (2011). Esophageal Cancer in the Elderly. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_60

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  • DOI: https://doi.org/10.1007/978-1-4419-6999-6_60

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