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Dezube AR, Cooper L, Mazzola E, Dolan DP, Lee DN, Kucukak S, De Leon LE, Dumontier C, Ademola B, Polhemus E, Bueno R, White A, Swanson SJ, Jaklitsch MT, Frain L, Wee JO. Long-term Outcomes Following Esophagectomy in Older and Younger Adults with Esophageal Cancer. J Gastrointest Surg 2022; 26:1119-1131. [PMID: 35357674 PMCID: PMC9474270 DOI: 10.1007/s11605-022-05295-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/02/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patterns of overall and disease-free survival after esophagectomy for esophageal cancer in older adults have not been carefully studied. METHODS Retrospective analysis of all patients with esophageal cancer undergoing esophagectomy from 2005 to 2020 at our institution was performed. Differences in outcomes were stratified by age groups, < 75 and ≥ 75 years old, and two time periods, 2005-2012 and 2013-2020. RESULTS A total of 1135 patients were included: 979 (86.3%) patients were < 75 (86.3%), and 156 (13.7%) were ≥ 75 years old. Younger patients had fewer comorbidities, better nutritional status, and were more likely to receive neoadjuvant and adjuvant therapy (all p < 0.05). However, tumor stage and operative approach were similar, except for increased performance of the McKeown technique in younger patients (p = 0.02). Perioperatively, younger patients experienced fewer overall and grade II complications (both p < 0.05). They had better overall survival (log-rank p-value < 0.001) and median survival, 62.2 vs. 21.5 months (p < 0.05). When stratified by pathologic stage, survival was similar for yp0 and pathologic stage II disease (both log-rank p-value > 0.05). Multivariable Cox models showed older age (≥ 75 years old) had increased hazard for reduced overall survival (HR 2.04 95% CI 1.5-2.8; p < 0.001) but not disease-free survival (HR 1.1 95% CI 0.78-1.6; p = 0.54). Over time, baseline characteristics remained largely similar, while stage became more advanced with a rise in neoadjuvant use and increased performance of minimally invasive esophagectomy (all p < 0.05). While overall complication rates improved (p < 0.05), overall and recurrence-free survival did not. Overall survival was better in younger patients during both time periods (both log-rank p < 0.05). CONCLUSIONS Despite similar disease-free survival rates, long-term survival was decreased in older adults as compared to younger patients. This may be related to unmeasured factors including frailty, long-term complications after surgery, and competing causes of death. However, our results suggest that survival is similar in those with complete pathologic responses.
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Affiliation(s)
- Aaron R Dezube
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Lisa Cooper
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Emanuele Mazzola
- Division of Data Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Daniel P Dolan
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Daniel N Lee
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Suden Kucukak
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Luis E De Leon
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Clark Dumontier
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
- New England GRECC, VA Boston Healthcare System, Boston, MA, USA
| | - Bayonle Ademola
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Polhemus
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Raphael Bueno
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Abby White
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Scott J Swanson
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Michael T Jaklitsch
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Laura Frain
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Jon O Wee
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Dezube AR, Cooper L, Mazzola E, Dolan DP, Lee DN, Kucukak S, De Leon LE, Dumontier C, White A, Swanson SJ, Jaklitsch MT, Frain LN, Wee JO, Ademola B, Polhemus E. Perioperative Esophagectomy Outcomes in Older Esophageal Cancer Patients in Two Different Time Eras. Semin Thorac Cardiovasc Surg 2022; 35:412-426. [PMID: 35248724 PMCID: PMC10049881 DOI: 10.1053/j.semtcvs.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022]
Abstract
To investigate perioperative outcomes of esophagectomies by age groups. Retrospective analysis of esophageal cancer patients undergoing esophagectomy from 2005 to 2020 at a single academic institution. Baseline characteristics and outcomes were analyzed by 3 age groups: <70, 70-79, and ≥80 years-old. Sub-analysis was done for 2 time periods: 2005-2012 and 2013-2020. Of 1135 patients, 789 patients were <70, 294 were 70-79, and 52 were ≥80 years-old. Tumor characteristics, and operative technique were similar, except positive longitudinal margins rates (all <3%) (P = 0.008). Older adults experienced increased complications (53.6% vs 69.7% vs 65.4% respectively; P < 0.001) attributable to grade II complications (41.4% vs 62.2% vs 63.5% respectively; P < 0.001). Hospital length of stay (LOS) and rehabilitation requirements were higher in older adults (both P < 0.05). 30-day readmissions, reoperation, and 30-day mortality rates (all <2%) showed no association with age group. Overall complications, LOS, discharge disposition and re-operative rates improved from 2005 to 2012 to 2013-2020 for all (P < 0.05). Increasing age was an independent risk factor for cardiovascular complications (OR 1.7, 95% CI 1.23-2.46 for ages 70-79 and OR 2.7, 95% CI 1.37-5.10 for ages ≥80 ), inpatient rehabilitation (OR 3.3, 95% CI 2.26-5.05 for ages 70-79 and OR 12.1 95% CI 5.83-25.04 for ages ≥80), and prolonged LOS (OR 1.64 95% CI 1.16-2.31 for ages 70-79 and OR 3.6 95% CI 1.71-7.67 for ≥80. After adjusting for time period, older age remained associated with complications (P < 0.05). Highly selected older adults at a large volume esophagectomy center can undergoesophagectomy with increased minor complication and rehabilitation needs.
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Affiliation(s)
- Aaron R Dezube
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Lisa Cooper
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emanuele Mazzola
- Division of Data Sciences, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Daniel P Dolan
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel N Lee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Suden Kucukak
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Luis E De Leon
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Clark Dumontier
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; New England GRECC, VA Boston Healthcare System, Boston, Massachusetts
| | - Abby White
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Laura N Frain
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon O Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bayonle Ademola
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Polhemus
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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