Background: Conflicting information with regards to morbidity and mortality has been reported for esophagogastrectomy in octogenarians.
Methods: From our prospectively maintained database, all patients 80-years of age and older who underwent esophagogastrectomy at our institution between January 1999 and December 2005 were identified and their records reviewed.
Results: There were 34 patients (30 men and 4 women). Median age was 81.8 years (range: 80 to 86 years). Twenty-eight patients (82%) were symptomatic at presentation. Most common were dysphagia in 17 patients (50%) and bleeding in 8 (23%). Comorbdities included hypertension in 22 patients (64%), coronary artery disease in 14 (41%), cardiac arrhythmias in 6 (17%), and diabetes and renal failure in 4 each (11%). Histopathology was adenocarcinoma in 30 patients (88%) and squamous cell in 3 (8%). One patient (2%) had end-stage achalasia without malignancy. Four patients (11%) received neoadjuvant chemoradiation therapy. The type of esophagogastrectomy included Ivor Lewis in 19 patients (56%), transhiatal in 11 (32%), and McKeown in 4 (12%). Pathologic stage was 0 or I in 12 patients (35%), II in 12 (35%), and stage III in 10 (29%). Operative mortality occurred in 2 patients (5.9%). Complications occurred in 24 patients (70%)and included: pulmonary in 11 (32%), atrial fibrillation in 10 (29%), aspiration in 6 (21%), and anastomotic leak in 5 (15%). Only 1 patient with anastomotic leak required reoperation. Median hospitalization was 11.5 days (range: 6 to 83 days). Overall morbidity was more common in patients with a prior cardiac history, patients whose BMI was > 30, or patients who had a McKeown procedure. In particular, pulmonary complications were more common in patients who had a history of major cardiac disease, or underwent a McKeown procedure. One-,two-, three-, and five-year survivals were 63%, 38%, and 30%, and 15% respectively.
Conclusion: Esophagogastrectomy in octogenarians can be performed with low mortality but has high morbidity. Increasing morbidity is associated with a history of major cardiac disease, BMI > 30, and performance of the McKeown esophagogastrectomy procedure.