Lookup NU author(s): Anantha Madhavan,
Dr Nicola Wyatt,
Professor Michael Griffin
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Background Oesophageal cancer incidence has increased over the last decade in the UK, particularly in older patients. Surgery, with or without perioperative chemotherapy, remains the gold standard treatment for patients with potentially curable disease. Currently, 41% of new cases of oesophageal cancer are in patients aged over 70. However, only 10% underwent surgery compared to 25% of those aged under 70. Concerns exist that advanced age may prejudice treatment decisions. The aim of our review is to evaluate the impact of age on outcomes in those undergoing planned curative treatment for oesophageal cancer. Methods A retrospective review of patients undergoing oesophagectomy for carcinoma between 2006 to 2016 at a single institution was performed. Patients were divided into two cohorts based on age at the time of diagnosis; under 70 years (Group A) and over 70 (Group B). Patients underwent a standardised staging protocol and treatment was decided by a multi-disciplinary team. Oesophagectomy was performed using a transthoracic approach with two field lymphadenectomy and perioperative chemo (radio) therapy used in those patients with locally advanced disease who were fit enough. Results There were 555 patients in Group A and 241 in Group B. Adenocarcinoma was the prevalent histological subtype in both cohorts: 76% (423) in Group A and 68% (165) in Group B. Median age at the time of diagnosis was 62 in Group A versus 74 in Group B. In Group A, 12% (18/343) did not receive neo-adjuvant treatment for locally advanced cancer versus 47% (101/212) in Group B (P < 0.001). Median hospital stay was longer in Group B (18 v 15 days P = 0.02). There was no significant difference in hospital mortality (Group A 1% vs Group B 2.4% P = 0.37) and major complication rate (Group A 14% vs Group B 20% P = 0.31). Two-year survival was 66% (adenocarcinoma) and 78% (SCC) in Group A compared to 60% (adenocarcinoma) and 64% (SCC) in Group B. Conclusion These results demonstrate that patients over 70 can be treated successfully with minimal additional risk to morbidity and mortality. However, these patients are more likely to be denied neoadjuvant treatment which may compromise their long-term outcomes.
Author(s): Madhavan A, Wyatt N, Boreham C, Phillips AW, Griffin SM
Publication type: Conference Proceedings (inc. Abstract)
Publication status: Published
Conference Name: 16th World Congress of the International Society for Diseases of the Esophagus
Year of Conference: 2018
Print publication date: 01/09/2018
Online publication date: 14/09/2018
Acceptance date: 01/05/2018
Publisher: Oxford University Press
Series Title: Diseases of the Esophagus