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Outcomes of curative esophageal cancer surgery in elderly: A meta-analysis

Authors
  • Baranov, Nikolaj S
  • Slootmans, Cettela
  • van Workum, Frans
  • Klarenbeek, Bastiaan R
  • Schoon, Yvonne
  • Rosman, Camiel
Type
Published Article
Journal
World Journal of Gastrointestinal Oncology
Publisher
Baishideng Publishing Group Inc
Publication Date
Feb 15, 2021
Volume
13
Issue
2
Pages
131–146
Identifiers
DOI: 10.4251/wjgo.v13.i2.131
PMID: 33643529
PMCID: PMC7896422
Source
PubMed Central
Keywords
License
Green

Abstract

BACKGROUND An increasing number of older patients is undergoing curative, surgical treatment of esophageal cancer. Previous meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients, which may lead to patient selection based on age. However, only studies including patients that underwent open esophagectomy were included. Therefore, it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive esophagectomy. AIM To perform a systematic review on age and postoperative outcome in esophageal cancer patients undergoing esophagectomy. METHODS Studies comparing older with younger patients with primary esophageal cancer undergoing curative esophagectomy were included. Meta-analysis of studies using a 75-year age threshold are presented in the manuscript, studies using other age thresholds in the Supplementary material . MEDLINE, Embase and the Cochrane Library were searched for articles published between 1995 and 2020. Risk of bias was assessed with the Newcastle-Ottawa Scale. Primary outcomes were anastomotic leak, pulmonary and cardiac complications, delirium, 30- and 90-d, and in-hospital mortality. Secondary outcomes included pneumonia and 5-year overall survival. RESULTS Seven studies (4847 patients) using an age threshold of 75 years were included for meta-analysis with 755 older and 4092 younger patients. Older patients (9.05%) had higher rates of 90-d mortality compared with younger patients (3.92%), (confidence interval = 1.10-5.56). In addition, older patients (9.45%) had higher rates of in-hospital mortality compared with younger patients (3.68%), (confidence interval = 1.01-5.91). In the subgroup of 2 studies with minimally invasive esophagectomy, older and younger patients had comparable 30-d, 90-d and in-hospital mortality rates. CONCLUSION Older patients undergoing curative esophagectomy for esophageal cancer have a higher postoperative mortality risk. Minimally invasive esophagectomy may be important for minimizing mortality in older patients.

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