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Esophageal Surgery for Malignant Disease in the Elderly

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Cardiothoracic Surgery in the Elderly

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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. 16,470 Americans are diagnosed with and 14,280 die of esophageal cancer annually, and the incidence is increasing. In fact, the incidence of esophageal adenocarcinoma (EAC) has increased in the last 25 years, greater than the incidence of any other major malignancy in the United States. Esophageal cancer is primarily a disease of the elderly. The median age at diagnosis is 69 years, with 61.5% of those diagnosed being age 65 or older. While surgery remains the best single modality of therapy in terms of survival and durable control of dysphagia, careful patient selection and medical optimization of existing comorbidities is of paramount importance in maintaining acceptable surgical outcomes, especially in the elderly. Whether postsurgical outcome in the elderly is worse than for younger patients remains controversial. It seems likely that the best possible surgical outcomes are obtained in elderly patients who are meticulously screened, medically optimized with regards to existing comorbidities, and undergo surgery in a high-volume tertiary referral center. Recent data suggest that elderly patients with early EAC have improved survival following surgery rather than chemoradiation. Palliative esophagectomy for advanced stage malignancy is associated with mortality rates in excess of 20% and morbidity rates as high as 50% and should therefore be avoided. Very effective palliation can be obtained with chemotherapy, radiation therapy, and endoscopic interventions such as stenting.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Texas A&M University Health Science Center College of Medicine, Scott & White Memorial Hospital and Clinic, Olin E. Teague Central Texas VA Medical Center, Temple, TX, 76508, USA

    Philip A. Rascoe

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  1. Philip A. Rascoe
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  2. John C. Kucharczuk
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Correspondence to Philip A. Rascoe .

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  1. , Department of Thoracic Surgery, Geisinger Wyoming Valley Medical Center, 1000 East Mountain Drive, Wilkes-Barre, 18711, Pennsylvania, USA

    Mark R. Katlic

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Rascoe, P.A., Kucharczuk, J.C. (2011). Esophageal Surgery for Malignant Disease in the Elderly. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_45

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