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Keith S. Naunheim
Joseph Zwischenberger
Mark W. Turrentine
Kenneth A. Kesler
Laurie B. Reeder
Mark K. Ferguson
Arthur E. Baue
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Ann Thorac Surg 1993;56:880-884
© 1993 The Society of Thoracic Surgeons

Articles

Esophagectomy in the septuagenarian

Keith S. Naunheim, MD*,a,b,c,d, James Hanosh, MDa,b,c,d, Joseph Zwischenberger, MDa,b,c,d, Mark W. Turrentine, MDa,b,c,d, Kenneth A. Kesler, MDa,b,c,d, Laurie B. Reeder, MDa,b,c,d, Mark K. Ferguson, MDa,b,c,d, Arthur E. Baue, MDa,b,c,d

a Departments of Surgery, St. Louis University Medical Center, St. Louis, Missouri USA
b Indiana University Medical Center, Indianapolis, Indiana USA
c The University of Chicago Medical Center, Chicago, Illinois USA
d The University of Texas Medical Branch, Galveston, Texas USA

* Address reprint requests to Dr Naunheim, Department of Surgery, St. Louis University Medical Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250.

As the population continues to age, older patients are being referred for thoracic surgical procedures with increasing frequency. From 1985 through 1992, 38 patients (32 men, 6 women) 70 years of age or older underwent esophagectomy for primary esophageal carcinoma. Histologic findings included adenocarcinoma in 28 (74%) and squamous carcinoma in 10 (26%). Patients suffered dysphagia for a mean of 3.8 months (range, 0 to 30 months) and had a mean weight loss of 5.8 kg (range, 0 to 22 kg). The tumors ranged from 1 to 14 cm in length and averaged 4.7 cm. Preoperative chemotherapy and radiation therapy were administered in 11 patients (46%). Clinical staging suggested all patients were curable, and esophagectomy was performed in a transthoracic fashion in 27 (71%) and from a transhiatal approach in 11 (29%). Cervical anastomoses were undertaken in 16 patients (42%). The mean blood loss was 1,165 mL and ranged from 500 to 4,000 mL. The mean number of transfused units was 2.3 (range 0 to 8 U). Overall operative mortality was 18% (7 of 38). Major morbidity included pneumonia in 11 (29%), anastomotic leak in 4 (11%), chylothorax in 4 (11%), pulmonary embolus in 3 (8%), and stroke and myocardial infarction in 1 patient each (3%). Three patients have been cured of their esophageal cancer with survivals of 65, 70, and 72 months and an additional 7 patients are still alive. Three patients (8%) have been lost to follow-up. These data suggest that (1) esophagectomy can be performed in selected septuagenarian patients with an increased but acceptable mortality, and (2) longterm survival with good functional status is attainable in this age group in a portion of these patients.




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