Evaluating the perioperative risks in esophageal resection and reconstruction for esophageal carcinoma among elderly patients: A retrospective propensity score matching analysis

Ji Yong Kim; Jae Kwang Yun; Hyeong Ryul Kim; Seung-Il Park; Yong-Hee Kim

doi:10.1016/j.ejso.2024.109542

Evaluating the perioperative risks in esophageal resection and reconstruction for esophageal carcinoma among elderly patients: A retrospective propensity score matching analysis

Eur J Surg Oncol. 2024 Dec 10;51(3):109542. doi: 10.1016/j.ejso.2024.109542. Online ahead of print.

Authors

Ji Yong Kim¹, Jae Kwang Yun¹, Hyeong Ryul Kim¹, Seung-Il Park¹, Yong-Hee Kim²

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
² Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: kimyh67md@hotmail.com.

PMID: 39689463
DOI: 10.1016/j.ejso.2024.109542

Abstract

Introduction: With the global aging, the number of elderly candidates for esophageal resection is increasing. However, studies on esophagectomy in elderly patients have yielded conflicting results, and individuals over 75 years old are frequently excluded from studies on esophageal cancer. This study aimed to analyze perioperative and survival outcomes post-esophagectomy in elderly patients using propensity score matching (PSM).

Materials and methods: Patients with esophageal carcinoma who underwent esophagectomy (2006-2020) were studied. A 1:2 PSM was performed, with matching variables, including operational approach, type of operation, Charlson Comorbidity Index without age score, clinical stage, and treatment modality. Perioperative and survival outcomes were compared between the age groups.

Results: After PSM, 91 elderly and 182 non-elderly patients were analyzed. The postoperative in-hospital mortality rate was identical for both groups at 1.1 %. The non-elderly group had a significantly higher 4-week discharge rate (91.8 % vs. 84.6 %, p = 0.032). There were no significant differences in overall postoperative complications (p = 0.886). Grade III-IV complications occurred in 16.5 % of elderly and 8.8 % of non-elderly patients, with no significant difference (p = 0.092). The 5-year overall survival rate was significantly lower in the elderly group (47.3 % vs. 69.8 %, p = 0.022), while the 5-year recurrence-free survival rate showed no significant difference (45.7 % vs. 63.6 %, p = 0.119).

Conclusions: Elderly patients undergoing esophagectomy were similar to non-elderly patients in overall complications and in-hospital mortality. Despite a tendency for increased severity of complications and a significantly lower 4-week discharge rate, esophagectomy remains acceptable for elderly patients.

Keywords: Complications; Elderly patient; Esophageal carcinoma; Esophageal reconstruction; Esophageal resection; Esophagectomy.