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.

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.

PS01.046: ENDOSCOPIC THERAPY FOR ESOPHAGEAL VARICES IN THE ELDERLY CAN BE PERFORMED IN SAFETY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 63-63
Author(s):  
Ryo Sasaki ◽  
Takuya Iwamoto ◽  
Tatsuro Nishimura ◽  
Isao Sakaida
Keyword(s):  
Elderly Patients ◽  
Esophageal Varices ◽  
Conflicts Of Interest ◽  
Endoscopic Therapy ◽  
The Elderly ◽  
Gastric Varices ◽  
Elderly Group ◽  
Significant Difference ◽  
Before And After ◽  
Blood Data

Abstract Background In this study, we evaluated the risk of complications and the effects of the treatment of esophageal varices in elderly patients with cirrhosis, by comparing the data of elderly and non-elderly patients. Methods We included 284 patients who received endoscopic therapy for esophageal and gastric varices at our hospital between February 2004 and December 2016 in the study.The subjects were divided into two groups.An elderly group comprising patients who were 65 years of or order.A Non-elderly group comprising patients who were under 65 yearsWe compared various parameters such as blood data before and after the endoscopic therapy, as well as the complications associated with the treatment, and then performed statistical analyses on the results. Results Of the 284 subjects, 168 patients were elderly group 65 years or older and 116 patients were non-elderly groupaged less than 65 years. Complications were observed in 30 of 168 subjects (17.8%) in the elderly groupwho were aged 65 years or greater and in 25 of 116 subjects (21.6%) under 65 yearsin the non-elderly group, which did not indicate a significant difference between the two groups. The Child-Pugh score was 6.6 ± 0.1 in the elderly group and 7.1 ± 0.2 in the non-elderly group, indicating that the score was significantly lower in the elderly group (P < 0.05). Our investigation of the patients’ medical history pertaining to liver complications indicated that 32.3% of the subjects in the non-elderly group were alcoholics, as compared to 14.8% in the elderly group, indicating a significantly higher percentage of alcoholics in the non-elderly group (P < 0.01). Our investigation of the efficacy of the treatment of varices indicated that the recurrence rate within 1 year was 29.2% in the elderly group and 28.0% in the non-elderly group, indicating that there was no significant difference between the two groups. Conclusion Our study comparing the endoscopic treatment of esophageal varices in the elderly and the non-elderly revealed that there were no significant differences in the increase in the risk of complications or the efficacy of treatment. Therefore, we believe aggressive treatment shouldmay be considered even for elderly patients to avoid the risk of variceal rupture and bleeding. Disclosure All authors have declared no conflicts of interest.

scholarly journals Clinical Outcomes of Radiotherapy in Elderly and Younger Patients with T4 Esophageal Cancer: A Retrospective Single-Center Analysis

2021 ◽  
Author(s):  
Yosuke Takakusagi ◽  
Kio Kano ◽  
Satoshi Shima ◽  
Keisuke Tsuchida ◽  
Nobutaka Mizoguchi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Outcomes ◽  
Complete Response ◽  
The Elderly ◽  
Elderly Group ◽  
Cancer Center ◽  
Esophageal Fistula ◽  
Younger Patients ◽  
Significant Difference ◽  
T4 Esophageal Cancer

Abstract Background/AimThe standard of treatment for esophageal cancer with adjacent organ invasion (T4) has not been established. Radiotherapy (RT) is a treatment option, but its efficacy and safety in elderly patients remains unclear. We retrospectively analyzed the clinical outcomes of RT in elderly and younger patients with T4 esophageal cancer.Materials and MethodsSixty-nine patients with T4 esophageal cancer who underwent RT at the Kanagawa Cancer Center between January 2014 and November 2020 were included in this study. Patients aged ≥70 years were defined as the elderly group and those aged <70 years were defined as the younger group.The total dose of RT was set at 60 Gy in 30 fractions. Chemotherapy combined with 5-fluorouracil and cisplatin was administered concurrently with RT. The overall survival (OS) rate was estimated using the Kaplan–Meier method. Adverse events were assessed using the CTCAE v4.0. Clinical outcomes were compared between the elderly and younger groups.ResultsThe median survival time (MST) of the elderly group was 21.5 months, and the OS rates at 1, 3, and 5 years were 63.7%, 31.3%, and 15.6%, respectively. The MST of the younger group was 12.5 months, and the OS rates at 1, 3, and 5 years were 52.2%, 29.4%, and 29.4%, respectively. A significant difference in OS was not observed between the two groups (p = 0.767). Themultivariate analysis revealed thatthe complete response (CR) of the primary tumor and adjuvant chemotherapy (ACTx) were significant predictors of OS (p< 0.001 and<0.001, respectively). Regarding toxicity, the frequency of thrombocytopenia was significantly higher in the elderly group, whereas the frequency of esophageal fistula was significantly higher in the younger group (p = 0.012 and 0.022, respectively). Other toxicities were not significantly different between the two groups.ConclusionsOS was not significantly different between the elderly and younger groups. ACTx and CR were predictors of OS. The frequency of thrombocytopenia was higher in the elderly group and that of esophageal fistula was higher in the younger group. However, other toxicities were not significantly differentbetween the two groups.

scholarly journals Efficacy, safety, and adherence of tocilizumab therapy in elderly patients with rheumatoid arthritis: A real-world observational study

2021 ◽  
Vol 19 ◽  
pp. 205873922110457
Author(s):  
Yoshinobu Nakao ◽  
Yu Funakubo Asanuma ◽  
Takuma Tsuzuki Wada ◽  
Mayumi Matsuda ◽  
Hiroaki Yazawa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Elderly Patients ◽  
Disease Activity ◽  
Activity Index ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Drug Survival ◽  
Significant Difference

Objective: We evaluated the efficacy, safety, and drug survival rate of tocilizumab in the elderly patients with rheumatoid arthritis (RA). Methods: This study was conducted in 108 RA patients who started tocilizumab between 2008 and 2018. The patients were divided into a young group (<65 years) and an elderly group (≥65 years). The efficacy, safety, and drug survival rate of tocilizumab were compared between the two groups. Results: At baseline, there were no significant differences between the elderly ( n = 45) and the young group ( n = 63) in RA duration, percentage of biologic-naïve, and RA disease activity. Health Assessment Questionnaire-Disability Index (HAQ-DI) was higher, renal function was worse, and frequency of using methotrexate was lower in the elderly group. Tocilizumab demonstrated similar efficacy in the elderly and the young group with Clinical Disease Activity Index and HAQ-DI. Compared with baseline, the frequency of steroid use was lower at one year after initiation of tocilizumab in both groups. There was no significant difference between the groups in the drug survival rate of tocilizumab for three years. Discontinuation rates of TCZ due to toxic adverse events were similar between the two groups. Conclusions: The efficacy, steroid-sparing effect, and safety of tocilizumab therapy, as well as the drug survival rate for three years, were not inferior in elderly RA compared to young RA patients.

PS01.197: SURVIVAL COMPARISON BETWEEN IVOR-LEWIS AND MCKEOWN MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A PROSPECTIVE RANDOMIZED STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 105-106
Author(s):  
Jang-Ming Lee ◽  
Pei-Hsing Chen
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Disease Progression ◽  
Minimally Invasive Esophagectomy ◽  
Progression Free Survival ◽  
Survival Duration ◽  
Ivor Lewis ◽  
Free Survival ◽  
Invasive Esophagectomy ◽  
Significant Difference

Abstract Background Both Ivor Lewis (anastomosis in the chest) and McKeown (anastomosis in the neck) esophagectomy has been used to treat patients with esophageal cancer. It is unclear in literature about the survival difference performed by these two methods. Methods A prospective randomized trial enrolling 100 patients with esophageal cancer in the middle or lower esophagus was done to compare the survival outcome treated with minimally invasive esophagectomy by Ivor Lewis and McKeown approaches. Analysis for the retrospective patient cohort (n = 253) including Ivor Lewis (n = 115) and McKeown (n = 138) MIE in the same hospital was also performed. Results There is no significant difference in the overall and disease progression-free survival duration between the two groups of patients (n = 50 for each group) (Figure 1 for overall survival). Similar results were found when the comparison was done for the retrospective and whole patients cohort. Multivariate analysis demonstrates the TNM staging of the tumor to be the single significant factor for prognosis in terms of overall and disease progression-free survival. There was no significant difference in overall and disease progression- free survival between the patients with Ivor Lewis and McKeown MIE both in prospective and retrospective study cohort. Conclusion Ivor Lewis and McKeown MIE provide a similar survival results for the patients with esophageal cancer in the middle and lower thoracic esophagus. Disclosure All authors have declared no conflicts of interest.

scholarly journals Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mitsuro Kanda ◽  
Masahiko Koike ◽  
Chie Tanaka ◽  
Daisuke Kobayashi ◽  
Masamichi Hayashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Neoadjuvant Treatment ◽  
The Elderly ◽  
Elderly Group ◽  
Elderly Age ◽  
Subtotal Esophagectomy

Abstract Background The global increase in elderly populations is accompanied by an increasing number of candidates for esophagectomy. Here we aimed to determine the postoperative outcomes after subtotal esophagectomy in elderly patients with esophageal cancer. Methods Patients (n = 432) with who underwent curative-intent transthoracic subtotal esophagectomy with 2- or 3-field lymphadenectomies for thoracic esophageal cancer were classified as follows: non-elderly (age < 75 years, n = 373) and elderly (age ≥ 75 years, n = 59) and groups. To balance the essential variables including neoadjuvant treatment and stage of progression, we conducted propensity score analysis, and clinical characteristics, perioperative course and prognosis were compared. Results After two-to-one propensity score matching, 100 and 50 patients were classified in the non-elderly and elderly groups. The elderly group had more comorbidities and lower preoperative cholinesterase activities and prognostic nutrition indexes. Although incidences of postoperative pneumonia, arrhythmia and delirium were slightly increased in the elderly group, no significant differences were observed in overall incidence of postoperative complications, rates of repeat surgery and death caused by surgery, and length of postoperative hospital stay between the two groups. There were no significant differences in disease-free and disease-specific survival as well as overall survival between the two groups. Conclusion Older age (≥75 years) had limited impact on morbidity, disease recurrence, and survival after subtotal esophagectomy. Therefore, age should not prevent older patients from benefitting from surgery.

End to side circular stapled anastomosis during robotic-assisted Ivor Lewis minimally invasive esophagectomy (RAMIE)

2022 ◽  
Author(s):  
Giovanni Capovilla ◽  
Edin Hadzijusufovic ◽  
Evangelos Tagkalos ◽  
Caterina Froiio ◽  
Felix Berlth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Primary Outcome ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Mortality ◽  
The Other ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Abstract Robotic-assisted minimally invasive esophagectomy (RAMIE) represents an established approach for the treatment of esophageal cancer. Aim of this study is to evaluate the feasibility and safety of our technique for performing the intrathoracic anastomosis during RAMIE.All the procedures were performed by the same surgeon using the same technique for performing the intrathoracic anastomosis. Intraoperative and postoperative outcomes were recorded. Postoperative complications were classified according to the Esophagectomy Complications Consensus Group (ECCG); the primary outcome was the evaluation of the feasibility and safety of our technique. From 2016 to 2021, 204 patients underwent Ivor Lewis RAMIE at our Center. Two patients (0.9%) were converted during the thoracic phase. The anastomosis was completed in all the other patients forming complete anastomotic rings. The median duration for the robotic-assisted thoracoscopic phase was 224 minutes. Twenty-two of the RAMIE-Ivor Lewis patients had an anastomotic leakage (10.3%). The overall 90-day postoperative mortality was 1.9%. The procedure resulted to be feasible and safe in our cohort of patients.

Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression

2021 ◽  
Author(s):  
Hua Zhao ◽  
Jin Zhu ◽  
Yin-da Tang ◽  
Lin Shen ◽  
Shi-ting Li
Keyword(s):  
Elderly Patients ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Facial Palsy ◽  
The Elderly ◽  
Elderly Group ◽  
Effective Treatment Option ◽  
Younger Patients ◽  
Significant Difference ◽  
Csf Leakage

Abstract Objective The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years). Methods In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups. Results At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma. Conclusions MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.

145 ADVANTAGES OF MINIMALLY INVASIVE TRANSMEDIASTINAL ESOPHAGECTOMY IN ELDERLY PATIENTS WITH ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kei Nakamura ◽  
Atsushi Shiozaki ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Michihiro Kudo ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Significant Difference ◽  
Transmediastinal Esophagectomy

Abstract   Esophagectomy for esophageal cancer (EC) is one of the most invasive surgical procedures and, especially for elderly patients, postoperative respiratory complication (PRC) is still frequent and life-threatening. We started esophagectomy by a laparoscopic transhiatal approach in 2009, and single-port mediastinoscopic cervical approach in 2014. Nowadays, we have performed total mediastinal lymph node dissection without thoracic approach. The purpose of this study was to evaluate transmediastinal esophagectomy (TME) for the prevention of PRC in elderly patients. Methods 1) Patients with EC performed TME (n = 238) were compared with those performed the right thoracotomy (n = 185). 2) Outcomes of TME for elderly patients (75 years and older, n = 48) was evaluated by comparing with non-elderly patients (n = 190). 3) Elderly patients performed subtotal esophagectomy were divided into 2 groups according to the presence (n = 12) or absence (n = 51) of PRC. The two groups were compared about clinicopathological factors, and risk factors of PRC were analyzed. Results 1) Percentage of elderly patients was higher in TME group (20.2% vs 8.1%). The operative time and bleeding were decreased by TME. The number of resected LNs and pR0 rate were not different between two groups. In TME groups, the occurrence of PRC was significantly reduced (10.1% vs 28.1%). 2) 81.3% of elderly patients were able to extubation on 0POD, and there was no significant difference in PRC between two groups. 3) Univariate analysis showed that surgical approach was significantly different between two groups. Multivariate analysis showed that thoracotomy was the strongest risk factor of PRC for elderly patients. Conclusion This study showed that our surgical procedure was less invasive during operation and resulted in a safe en-bloc mediastinal lymph node dissection. For elderly patients, TME was the effective minimally invasive approach and was able to reduce the occurrence of PRC.

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.

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