Elderly Patients With Thoracic Esophageal Squamous Cell Carcinoma Surgical Approach Selection And Prognostic Analysis

Objective The clinical pathological data,intraoperative and postoperativefactors,postoperative survival situation were compared between the elderly and theyounger elderly patients with thoracic esophageal squamous cell carcinoma (ESCC),Independent prognostic factors in elderly patients analyzed by Cox regression model.Methods A retrospective review of371cases of elderly patients with thoracicesophageal squamous cell carcinoma (≥60years) between January2006and December2008were performed. Patients were divided into two age groups:≥75years old (theelderly group;53patients)and60-74years old (the younger elderly group;318patients),the clinicopathological factors, operational factors, postoperative hospital mortality andaverage length of stay were compared. Meanwhile according to different surgicalapproach, the comparison of the left chest and right chest approach of operative time,blood loss and postoperative complication rate, and so on and so forth. Finally, Thesurvival rate of the two groups of patients and different surgical approaches, especiallythe elderly group of different surgical approaches was calculated using theKaplan-Meier method and logrank test，Cox regression test was used for multivariateprognostic analysis.Results The elderly group compared with the younger elderly group had morepreoperative complications, particularly in terms of cardiovascular disease. PreoperativeASA classification and postoperative complications especially the incidence ofpulmonary complications, length of stay and hospital mortality rates were significantly higher. The very elderly group over the right chest approach had less postoperativecomplications, especially pulmonary complications, the results were statisticallysignificant. The elderly group compared with the younger elderly group had even worselong-term survival, Overall, the left chest had poorer prognosis than right chestapproach. but on the impact of different surgical approaches on prognosis of elderlygroup has no statistically significant difference. Multivariate analysis showed thatwhether lymph node metastasis was the independent factors affecting postoperativesurvival rate of elderly patients with esophageal cancer.Conclusion Comparison of elderly group with patients older than75years old andyounger elderly group with patients between the ages of60-74, the perioperative riskwas increased and long-term survival rate was significantly lower, we can chooserelatively simpler operation approach to reduce the incidence of postoperativecomplications, especially pulmonary complications. Comparing different surgicalapproach long-term prognosis in elderly group is no significant difference, however,combined with the causes of death in elderly group, this result was probably related tothe elderly group with shorter life expectancy and relatively slow progress of the tumorat the same time. Multivariate analysis showed age and surgical approach were notinfluence on prognosis, Whether lymph node metastasis is the only independent factorsaffecting the prognosis. Age is not a contraindication for surgery，elderly patients withesophageal cancer the same lymph node dissection should be performed in order toimprove the standardization of long-term survival. If multiple preoperativecomorbidities, higher ASA classification, they can choose relatively simple operation, inorder to reduce surgical risk and improve short-term prognosis, but also provide theconditions for a comprehensive sequential therapy.