M. Melis1, A. Masi1,2, A. Pinna1, I. Hatzaras1,2, S. Cohen1, R. S. Berman1, G. Ballantyne1, H. Pachter1, E. Newman1 1New York University School Of Medicine,New York, NY, USA
Introduction: Gastro-esophageal surgery can generally be performed with mortality lower than 5% and morbidity of 30-50%, but little is known about results of esophagectomy and gastrectomy in octogenarians. We investigated outcomes after resection of stomach and/or distal esophagus for cancer in patients ≥ 80 year-old.
Methods: From our gastro-esophageal cancer database we identified 289 patients who underwent surgery (1990-2010) for cancer. We categorized patients into two groups, according to age at time of surgery: Group O (≥ 80 year-old) and Group Y (< 80 year-old). The study end-points were overall morbidity, 30-day mortality, overall survival (OS). Differences between groups were evaluated using t-test or chi-squared test. Survival was compared using Kaplan–Meier analysis and log-rank test.
Results: There were 50 patients in group O (mean age 85) and 239 in Group Y (mean age 64.3). As expected, octogenarians had worse ECOG performance status (PS ≤ 1: 84% vs. 91.2%, p < 0.001) and higher incidence of specific comorbidities. Operative time, blood loss, AJCC stage, and status of resection margins were similar between groups. Octogenarians had similar 30-day morbidity (36.0% vs. 37.7%, p=0.82) and post-operative mortality (6% vs. 2.5%, p=1.96). At median follow-up of 21.8 months OS was 13.1 and 29.2 months respectively in Group O and Y (p=0.10)
Conclusions: In our experience, despite a higher incidence of pre-operative co-morbidities, early and long-term post-operative outcomes in octogenarians were similar to those of younger patients. Radical surgery can be safely offered to carefully selected octogenarians with gastric or esophageal cancer.