Society for Surgery of the Alimentary Tract

2005 Abstracts: Esophagectomy Can Be Performed Safely in Patients Over Seventy Years Old

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Esophagectomy Can Be Performed Safely in Patients Over Seventy Years Old
Anna Ibele, Patrick R. Pfau, Deepak V. Gopal, James P. Thomas, niloo m. Edwards, tracey weigel, University of Wisconsin, Madison, WI

Background: Increasing life expectancy and incidence of esophageal carcinoma, has resulted in more patients over seventy being evaluated for esophagectomy. Esophagectomy is associated wih a mortality as high as 17% in community hospitals. Thus, many surgeons are reluctant to consider esophagectomy in elderly patients, who are often assumed to be at high risk for perioperative complications. The purpose of this study was to compare postoperative morbidity and mortality of esophagectomy in elderly (>/=70 years old) versus younger patients (< 70 years old).

Methods:A retrospective review of a prospective database was performed; all patients who underwent esophagectomy between 2001-2004 were included. Preoperative risk factors studied include:weight loss, coronary artery disease, COPD, diabetes and smoking. Thirty-day morbidity and mortality rates were compared between the two patient populations. Results:No significant differences in preoperative risk factors including: weight loss, coronary artery disease, COPD, diabetes and tobacco use were identified between the two groups of patients. The median length of hospital stay was comparable in the two groups. The incidence of pneumonia, chylothorax, recurrent laryngeal nerve paralysis, anastomotic leak and/or stricture, reintubation, readmission and death-rates were similar in both cohorts. The incidence of pulmonary embolism was higher in patients >/=70 (P=0.01). (Table #1). Conclusion: Esophagectomy can be performed safely in patients >/= 70 years old with rates of morbidity and mortality comparable to that of patients < 70 years old, despite a higher rate of pulmonary embolism. Physicians should not discriminate against otherwise healthy elderly patients when evaluating them for esophagectomy. Table 1. Postoperative Complications

	<70 years (n =48)	>/=70 years (n=18)	P value
Median LOS	10	11.5
Pneumonia	7	4	0.5
Pulmonary Embolism	2	5	0.01
Chylothorax	3	2	0.6
Recurrent Laryngeal Paralysis	3	0	0.6
Anastamotic Leak	8	1	0.4
Polyneuropathy of Critically Ill	2	0 (0)	1
ARDS/Sepsis	2 (1 w/ ECMO)	1	1
Stricture >30 days	22	6	0.4
Readmit	5	2	1
Reintubation	4	4	0.2
Death	0	1	0.3

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