Preoperative Chemoradiotherapy Prior to Esophagectomy in Elderly Patients is Not Associated With Increased Morbidity

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Research in Aging Award

Preoperative Chemoradiotherapy Prior to Esophagectomy in Elderly Patients is Not Associated With Increased Morbidity

David C. Rice, MB, BCh^a^,*, Arlene M. Correa, PhD^a, Ara A. Vaporciyan, MD^a, Nidhi Sodhi, MD^a, W. Roy Smythe, MD^a, Stephen G. Swisher, MD^a, Garrett L. Walsh, MD^a, Joe B. Putnam, Jr, MD^a, Ritsuko Komaki, MD^b, Jaffer A. Ajani, MD^c, Jack A. Roth, MD^a

^a Department of Thoracic and Cardiovascular Surgery, Houston, Texas
^b Department of Radiation Oncology, Houston, Texas
^c Department of Gastrointestinal Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Accepted for publication August 5, 2004.

^* Address reprint requests to Dr Rice, University of Texas M. D. Anderson Cancer Center, Department of Thoracic and Cardiovascular Surgery, 1515 Holcombe, Unit 445, Houston, TX 77030 (E-mail: drice{at}mdanderson.org).

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: Preoperative chemotherapy and radiation therapy are often administeredto patients with esophageal cancer. Despite an aging population,little data exist regarding feasibility of preoperative therapyin elderly patients.

METHODS: Between January 1997 and December 2002, 312 consecutive patientsunderwent esophagectomy for esophageal cancer at our institution.Outcomes of patients 70 years old, who underwent preoperativetherapy (n = 35; group II), were compared with those of patientswho did not (n = 39; group I) and with those of patients youngerthan 70 years old who received preoperative therapy (n = 165;group III).

RESULTS: The median age was 75 years old for group I and 72 years forgroup II (p < 0.001). The patients in group II were of moreadvanced clinical stage (p < 0.001). There were no differencesin performance status, comorbidities, or preoperative symptomsbetween the two groups. Similar proportions of patients in thegroups I and II underwent a transhiatal approach (52.5% vs 42.8%,p = not significant [NS]). Perioperative mortality for groupsI and II was 0% and 3%, respectively (p = NS). Group II receivedmore perioperative blood transfusions (71.4% vs 48.7%, p = 0.047).There were no differences in the rates of postoperative cardiac,pulmonary, neurologic, gastrointestinal, or anastomotic complications.Compared with group III, group II patients had higher ratesof postoperative atrial arrhythmias (p = 0.013) and perioperativeblood transfusions (p = 0.004).

CONCLUSIONS: Elderly patients receiving preoperative therapy for esophagealcancer do not have an increased incidence of major postoperativecomplications. Elderly patients receiving preoperative therapyare more likely to develop postoperative atrial arrhythmiasand require transfusion than younger patients.

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