Achieving long term survival in oesophagectomy patients aged over 75. (August 2016)

• Record Type: Journal Article
• Authors: Oakley, Ben; Lamb, Christopher; Vohra, Ravinder; Catton, James
• Is Part Of: Annals of medicine and surgery. Volume 9(2016)
• Page Start: 15
• Page End: 21
• Publication Date: 2016-08
• Subjects: Oesophagectomy -- Oesophageal cancer; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2016.05.016
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Aims: Surgical resection is often the only curative treatment for oesophageal cancer. The aim of this retrospective cohort study was to analyse outcomes following oesophageal resection in patients aged 75 years and older and the impact of an Enhanced Recovery after Surgery (ERAS) program in this cohort. Methods: Patients aged over 75 years undergoing oesophagectomy between 2003 and 2013 were identified from a single centre using an electronic database. Data on pre-operative comorbidity, tumour stage and length of hospital stay (LOS) were collected. Complications were classified according to the Clavien-Dindo system. Thirty day, 1- and 5-year mortality rates were calculated. Results: 147 patients were identified with a median age of 78.5 (IQR 76.7–80.9). 33% (n = 44) had a grade 3 complication or higher. Median LOS in hospital was 16 days (IQR 13.0–22.0). Thirty-day mortality was 3.4%, 1-year and 5-year survival was 65% and 21% respectively. 45% of patients were enrolled into an Enhanced Recovery After Surgery program and they demonstrated a significantly reduced length of stay from 18 to 14 days (p = 0.005) and 30-day mortality from 6.2% to 0% (p = 0.04) compared to the time period before the program. Conclusion: Long-term survival is achievable in patients aged over 75 years. Highlights: Long term survival is achievable in patients over 75 undergoing oesophagectomy. The only factors that significantly affect long term survival are tumour stage and resection margins. Peri-operative mortality in patients aged over 75 can be reduced by using an enhanced recovery after surgery programme.