PS01.229: SHORT- AND LONG-TERM OUTCOMES OF MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ELDERLY PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 115-115
Author(s):  
Yusuke Muneoka ◽  
Yasuyuki Kawachi ◽  
Shigeto Makino ◽  
Yu Sato ◽  
Chie Kitami ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Survival Rates ◽  
The Elderly ◽  
Elderly Group ◽  
Transthoracic Esophagectomy ◽  
Long Term Outcomes ◽  
Short And Long Term

Abstract Background Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated. Methods We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups. Results There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥  grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively. Conclusion MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease. Disclosure All authors have declared no conflicts of interest.

Safety and feasibility of minimally invasive esophagectomy for elderly esophageal cancer patients

2020 ◽  
Author(s):  
Y Sugita ◽  
T Nakamura ◽  
R Sawada ◽  
G Takiguchi ◽  
N Urakawa ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Minimally Invasive Esophagectomy ◽  
The Elderly ◽  
Elderly Group ◽  
Hospital Death ◽  
Cancer Specific Survival ◽  
Invasive Esophagectomy ◽  
Short And Long Term

Summary The number of elderly patients with esophageal cancer has increased in recent years. The use of thoracoscopic esophagectomy has also increased, and its minimal invasiveness is believed to contribute to postoperative outcomes. However, the short- and long-term outcomes in elderly patients remain unclear. This study aimed to elucidate the safety and feasibility of minimally invasive esophagectomy in elderly patients. This retrospective study included 207 patients who underwent radical thoracoscopic esophagectomy for thoracic esophageal squamous cell carcinoma at Kobe University Hospital between 2005 and 2014. Patients were divided into non-elderly (&lt;75 years) and elderly (≥75 years) groups. A propensity score matching analysis was performed for sex and clinical T and N stage, with a total of 29 matched pairs. General preoperative data, surgical procedures, intraoperative data, postoperative complications, in-hospital death, cancer-specific survival, and overall survival were compared between groups. The elderly group was characterized by lower preoperative serum albumin levels and higher American Society of Anesthesiologists grade. Intraoperative data and postoperative complications did not differ between the groups. The in-hospital death rate was 4% in the elderly group, which did not significantly differ from the non-elderly group. Cancer-specific survival was similar between the two groups. Although overall survival tended to be poor in the elderly group, it was not significantly worse than that of the non-elderly group. In conclusion, the short- and long-term outcomes of minimally invasive esophagectomy in elderly versus non-elderly patients were acceptable. Minimally invasive esophagectomy is a safe and feasible modality for elderly patients with appropriate indications.

scholarly journals Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marius Kryzauskas ◽  
Augustinas Bausys ◽  
Justas Kuliavas ◽  
Klaudija Bickaite ◽  
Audrius Dulskas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Colorectal Resection ◽  
Primary Anastomosis ◽  
The Elderly ◽  
Long Term Outcomes ◽  
Short And Long Term

Abstract Background The proportion of elderly colorectal cancer (CRC) patients requiring surgery is increasing. Colorectal resection for left-sided cancers is the most controversial as the primary anastomosis or end-colostomy and open or minimally invasive approaches are available. Therefore, this study was conducted to investigate the short- and long-term outcomes in elderly patients after resection with primary anastomosis for left-sided CRC. Methods The cohort study included left-sided colorectal cancer patients who underwent resection with primary anastomosis. The participants were divided into non-elderly (≤75 years) and elderly (> 75 years) groups. Short- and long-term postoperative outcomes were investigated. Results In total 738 (82%) and 162 (18%) patients were allocated to non-elderly and elderly groups, respectively. Minimally invasive surgery (MIS) was less prevalent in the elderly (42.6% vs 52.7%, p = 0.024) and a higher proportion of these suffered severe or lethal complications (15.4% vs 9.8%, p = 0.040). MIS decreased the odds for postoperative complications (OR: 0.41; 95% CI: 0.19–0.89, p = 0.038). The rate of anastomotic leakage was similar (8.5% vs 11.7%, p = 0.201), although, in the case of leakage 21.1% of elderly patients died within 90-days after surgery. Overall- and disease-free survival was impaired in the elderly. MIS increased the odds for long-term survival. Conclusions Elderly patients suffer more severe complications after resection with primary anastomosis for left-sided CRC. The risk of anastomotic leakage in the elderly and non-elderly is similar, although, leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly.

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

2016 ◽  
Vol 101 (11-12) ◽  
pp. 554-561
Author(s):  
Toru Aoyama ◽  
Masaaki Murakawa ◽  
Yosuke Atsumi ◽  
Keisuke Kazama ◽  
Manabu Shiozawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Adenocarcinoma ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Surgical Mortality ◽  
Long Term Outcomes ◽  
Group A ◽  
Short And Long Term ◽  
Group B

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age &lt; 75 years; group A) and elderly patients (age ≥ 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P = 0.379 and P = 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P = 0.946 and 13.1% versus 16.0%, P = 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 470-470
Author(s):  
Keisuke Kazama ◽  
Toru Aoyama ◽  
Yosuke Atsumi ◽  
Masaaki Murakawa ◽  
Manabu Shiozawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Adenocarcinoma ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Group A ◽  
Short And Long Term ◽  
Group B

470 Background: The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been evaluated in elderly patients. Methods: This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into two groups; non-elderly patients(age <75 years: group A) and non-elderly patients (age ≥75 years: group B). The surgical morbidity, motality, overall survival (OS), and recurrence-free survival (RFS) rates in the two groups were compared. Results: A total of 221 patients were evaluated in the study. The overall complication rates are 44.8% in Group A and 52.6% in Group B. Surgical mortality was observed in 2 patients due to an abdominal abcess and cardiovascular disease in Group A (1.1%) and in 1 patient due to postoperative bleeding in Group B (2.6%). There were no significant differences (p=0.379 and p=0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and non-elderly patients (18.55% vs. 20.2%, p=0.946 and 13.1% vs. 16.0%, p=0.829 respectively). Conclusions: The short-term outcomes and long-term outcomes survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the non-elderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

RA05.09: THE INFLUENCE OF AGE ON OVERALL SURVIVAL AND COMPLICATIONS AFTER IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGEAL SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-29
Author(s):  
Nikolaj Baranov ◽  
Frans Van Workum ◽  
Jolijn Van Der Maas ◽  
Ewout Kouwenhoven ◽  
Marc Van Det ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Surgical Complications ◽  
Conflicts Of Interest ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Elderly Group ◽  
Ivor Lewis ◽  
Significant Difference

Abstract Background Worldwide, the number of elderly patients suffering from esophageal cancer is increasing due to the increasing incidence of esophageal cancer and increasing life expectancy of the general population. The effect of age on morbidity, mortality and survival after Ivor Lewis totally minimally invasive esophagectomy (TMIE) with curative intention are not well known since elderly patients have been excluded in randomized trials. Methods A retrospective analysis of a prospectively documented database from December 2010 to June 2017 was performed, including all patients who underwent Ivor Lewis TMIE with curative intent for esophageal cancer in three Dutch hospitals. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Postoperative complications, in-hospital mortality, 30 and 90 days mortality, long-term complications and survival were compared between these two groups. Results Four hundred and forty-six patients were included, 89 patients in the elderly group and 357 patients in the younger group. In the elderly group, a significantly higher incidence of non-surgical complications (77.5% versus 66.7%; P = 0.048), cardiovascular complications (24.7% versus 14.0%; P = 0.014) and delirium (27.0% versus 11.8%; P = 0.000) was found. There was no significant difference in surgical complications, overall complications, 30-day mortality, 90-day mortality, 1-year survival and 2-year survival. Conclusion Although Ivor Lewis TMIE in elderly patients is associated with a higher rate of non-surgical complications, it can be safely performed without increasing postoperative mortality. Disclosure All authors have declared no conflicts of interest.

The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

2018 ◽  
Vol 59 (5-6) ◽  
pp. 380-390 ◽  
Author(s):  
Yukiyasu Okamura ◽  
Teiichi Sugiura ◽  
Takaaki Ito ◽  
Yusuke Yamamoto ◽  
Ryo Ashida ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Propensity Matching ◽  
Short And Long Term ◽  
Overall Survival Rates

Background: With aging populations increasing in developed countries, the prevalence of elderly patients with hepatocellular carcinoma (HCC) is expected to rise. The aim of this study was to determine the short- and long-term outcomes of HCC surgery in elderly patients (≥75 years) using propensity score matching. Methods: The study group included 421 patients who underwent hepatectomy as their initial treatment with curative intent. The patients were divided into elderly (n = 111) and non-elderly (n = 310) groups. We applied propensity score matching – taking into consideration patient background, blood examination, and tumor factors – to minimize the effect of potential confounders. We then compared the results before and after the propensity matching. Results: Before propensity matching, the elderly group included significantly more patients with a high American Society of Anesthesiologists physical status (p < 0.001). In addition, they were taking antihypertensive drugs or an anticoagulant (both p < 0.001). The severe postoperative complications and the overall survival rates for these elderly patients were significantly poorer than for the non-elderly patients (p = 0.015 and p = 0.030, respectively). We then chose 70 patients from each group for whom the preoperative confounding factors were balanced and compared the two groups. The factors identified before matching (severe complications and overall survival rates) were no longer relevant, i.e. there were no significant differences between the two groups. Conclusion: Hepatectomy for HCC in elderly patients is justified.

scholarly journals Renal Dysfunction is a Risk Factor of Death after Gastric Endoscopic Submucosal Dissection in Elderly Patients Aged ≥80 Years

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Kenichiro Okimoto ◽  
Makoto Arai ◽  
Hideaki Ishigami ◽  
Takashi Taida ◽  
Keiko Saito ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Endoscopic Submucosal Dissection ◽  
The Elderly ◽  
Good Prognosis ◽  
Elderly Group ◽  
Long Term Outcomes ◽  
Submucosal Dissection ◽  
Severe Chronic Kidney Disease

Introduction. Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is well accepted. However, its adaptation for elderly patients is unclear. This study aimed to investigate the prognosis and long-term outcomes of ESD for EGC in elderly patients aged ≥80 years by comparing their findings to the findings of patients aged <80 years. Materials and Methods. The study included 533 patients (632 lesions). The patients were divided into an elderly group (age, ≥80 years; 108 patients; 128 lesions; mean age, 83.4 ± 2.7 years) and a nonelderly group (age, <80 years; 425 patients; 504 lesions; mean age, 69.6 ± 7.9 years). We compared patient and lesion characteristics, overall survival (OS), and disease-specific survival (DSS) between the 2 groups retrospectively. Multivariate analysis was performed to clarify the risk factors of death after ESD. Results. The rate of curative resection and adverse events was not significantly different between the groups. The mean survival time periods with regard to OS/DSS in the elderly and nonelderly groups were 75.8 ± 5.9 and 122.8 ± 2.6 months (P<0.05)/120.0 ± 3.0 and 136.4 ± 0.6 months (not significant), respectively. In the elderly group, eGFR <30 ml/min/1.73 m2 was an independent risk factor of death (hazard ratio = 5.32; 95% confidence interval = 1.39–20.5; P=0.015). Conclusion. ESD for EGC can be performed safely and can achieve high curability with good prognosis in elderly patients aged ≥80 years. After ESD, close attention should be paid to elderly patients with severe chronic kidney disease.

Effect of surgical start time on short- and long-term outcomes after minimally invasive esophagectomy: a propensity-score matching analysis

2020 ◽  
Author(s):  
Tao Bao ◽  
Xiao-Long Zhao ◽  
Kun-Kun Li ◽  
Ying-Jian Wang ◽  
Wei Guo
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Long Term Outcomes ◽  
Start Time ◽  
Short And Long Term ◽  
Mckeown Esophagectomy

Summary There is growing focus on the relationship between surgical start time and postoperative outcomes. However, the extent to which the operation start time affects the surgical and oncological outcomes of patients undergoing esophagectomy has not previously been studied. The purpose of this retrospective study was to investigate the potential effect of surgical start time on the short- and long-term outcomes for patients who underwent thoracoscopic–laparoscopic McKeown esophagectomy. From September 2009 to June 2019, a total of 700 consecutive patients suffering from esophageal cancer underwent thoracoscopic–laparoscopic McKeown esophagectomy in the Department of Thoracic Surgery at Daping Hospital. Among these patients, 166 esophagectomies were performed on the same day and were classified as the first- or second-start group. Patients in the first-start group were more likely to be older than those in the second-start group: (64.73 vs. 61.28, P = 0.002). In addition, patients with diabetes mellitus were more likely to be first-start cases (8.4 vs. 1.2%). After propensity score matching (52 matched patients in first-start cases and 52 matched patients in second-start cases), these findings were no longer statistically significant. There was no difference in the incidence rate of peri- or postoperative adverse events between the first- and second-start groups. The disease-specific survival rates and disease-free survival rates were comparable between the two groups (P = 0.236 and 0.292, respectively). On the basis of the present results, a later start time does not negatively affect the short- or long-term outcomes of patients undergoing minimally invasive McKeown esophagectomy.

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