ESOPHAGECTOMY WITH ENHANCED RECOVERY IS SAFE AND EFFECTIVE FOR THE ELDERLY
Christopher Hadjittofi*, Pedro Serralheiro, Hugh Warren, Edward Cheong, Michael P. Lewis, Bhaskar Kumar
Upper GI Surgery, Norfolk & Norwich University Hospital, Norwich, United Kingdom
Introduction: Recent evidence suggests that esophagectomy for cancer in patients ≥70 years old is associated with a higher risk of morbidity and mortality, as well as a longer length of hospital stay. The aim of our study is to evaluate the outcomes of elderly patients undergoing esophagectomy with Enhanced Recovery After Surgery (ERAS) in a high-volume centre which specialises in minimally invasive esophagectomy.
Methods: A single-centre, prospectively maintained esophagectomy database was analyzed to determine whether advanced age was associated with a significantly increased risk of morbidity, mortality, prolonged length of stay, or readmission. Two age-based analyses were performed: In the first analysis, patients <70 years old were compared to patients ≥70 years old; In the second analysis, patients <80 years old were compared to patients ≥80 years old.
Results: From 2014 through 2017, esophagectomy with ERAS was performed for 155 patients with cancer. Most (79.4%) patients were male. The median age was 67 years. 41.3% of patients were ≥70 years old, and 7.1% were ≥80 years old. The overall 90-day complication rate was 59.4%. The anastomotic leak rate was 14.2%. The 30- and 90-day mortality rates were 1.3% and 1.9% respectively. Median length of stay (LoS) was 7 days (IQR=5) and the readmission rate was 15.5%. There were no significant differences in complications, mortality, LoS, or readmission rates (p>0.05) in either analysis (<70 vs. ≥70 or <80 vs. ≥80).
Conclusion: Elderly patients with esophageal cancer can undergo esophagectomy with ERAS, achieving similar outcomes as a younger population. In an era of ever-increasing referrals for elderly patients, these findings are of major significance to esophagogastric cancer practice.
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