Adenocarcinoma of the esophagus and esophagogastric junction in patients older than 70 years: results of neoadjuvant radiochemotherapy followed by transthoracic esophagectomy.

AIM: The standard treatment of locally-advanced esophageal adenocarcinoma consists of neoadjuvant radiochemotherapy followed by surgical resection. Very little data are available concerning the feasibility of this strategy in patients older than 70 years of age. PATIENTS AND METHODS: Between 1996 and 2008, 118 patients underwent transthoracic esophagectomy with lymphadenectomy for adenocarcinoma of the esophagus and gastric cardia (Siewert I and II). These were divided into three groups for comparison: Group I (age less than 70 years, neoadjuvant treatment followed by surgery; n=66); Group II (age greater or equal to 70 years, surgery alone; n=32); Group III (age greater or equal to 70 years, neoadjuvant treatment followed by surgery; n=20). Data concerning comorbidities, type of intervention, morbidity, mortality, survival and quality of life were analyzed.
RESULTS: There was no difference among the three groups with regard to comorbidity and preoperative evaluation. The patients in Groups I and III had more locally-advanced tumors (P<0.001). There was some disparity between the types of surgery proposed. The Lewis-Santy esophagectomy was most commonly used (90%, 50%, and 65% respectively). The 90-day mortality was 8%, 15%, and 15% respectively. There was no statistically significant difference in the incidence of postoperative pulmonary, cardiac, or digestive complications among the three groups. No difference was found in 5-year survival and quality of life.
CONCLUSIONS: Neoadjuvant radiochemotherapy for elderly patients (age above 70 years) with esophageal adenocarcinoma did not seem to increase postoperative morbidity or mortality, nor was there any difference in quality of life, nor any effect on survival, no matter what the age of the patient.