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Is minimally invasive esophagectomy beneficial to elderly patients with esophageal cancer?

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Abstract

Background

Open esophagectomy (OE) in elderly patients with esophageal cancer is hazardous due to high surgical mortality and limited survival. The aim of this study was to explore whether minimally invasive esophagectomy (MIE) has perioperative or long-term benefits in elderly patients with esophageal cancer compared with OE.

Methods

Between February 2005 and June 2013, 407 patients older than 70 years underwent esophagectomy for esophageal cancer, including 89 who received MIE and 318 who received OE. A retrospective pair-matched study was performed to compare 116 patients (58 pairs) who underwent either OE or MIE. Patients were matched by age, sex, comorbidity, tumor location, histology, TNM stage, and operative approach. Perioperative and long-term outcomes were compared between the two groups.

Results

The overall incidence of postoperative complications was significantly lower in the MIE group than in the OE group (37.9 vs. 60.3 %, P = 0.016), especially incidence of pulmonary complications (20.7 vs. 39.7 %, P = 0.026). The mean length of hospital stay was also significantly shorter (10 days [range 7–70] vs. 12 days [range 8–106], P = 0.032). The perioperative mortality rate trended lower in the MIE group but was not significantly different (3.4 vs. 8.6 %, P = 0.435). Kaplan–Meier analysis showed that the median disease-specific survival time in the MIE group was significantly longer than in the OE group (>27 months [range 1–82] vs. 24 months [range 1–99], P = 0.003). No difference was found in overall survival (39 ± 8.9 vs. 22 ± 3.4 months, P = 0.070).

Conclusion

In surgical management of elderly patients with esophageal cancer, MIE is associated with lower rates of morbidity and pulmonary complications as well as longer disease-specific survival time. Whether it provides benefit to patients’ long-term survival requires further research.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant No. 81370587).

Disclosure

Jingpei Li, Yaxing Shen, Lijie Tan, Mingxiang Feng, Hao Wang, Yong Xi, and Qun Wang declare no conflict of interest.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Jingpei Li, Yaxing Shen, Lijie Tan, Mingxiang Feng, Hao Wang, Yong Xi & Qun Wang

  2. Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Jingpei Li

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  1. Jingpei Li
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  2. Yaxing Shen
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  3. Lijie Tan
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  4. Mingxiang Feng
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  5. Hao Wang
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  6. Yong Xi
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  7. Qun Wang
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Corresponding author

Correspondence to Mingxiang Feng.

Additional information

Jingpei Li, Yaxing Shen these authors contributed equally to this paper.

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Li, J., Shen, Y., Tan, L. et al. Is minimally invasive esophagectomy beneficial to elderly patients with esophageal cancer?. Surg Endosc 29, 925–930 (2015). https://doi.org/10.1007/s00464-014-3753-x

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  • DOI: https://doi.org/10.1007/s00464-014-3753-x

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