Outcomes of elderly patients following thoracoscopic esophagectomy for esophageal cancer

Purpose: Thoracoscopic esophagectomy (TE) is widely used for esophageal cancer treatment. However, the short- and long-term outcomes of TE in older patients remain unknown. Thus, we investigated those outcomes as well as the effectivity of TE in this patient cohort. Methods: : A total of 228 consecutive patients who underwent TE for esophageal cancer from 2002 to 2015 were included in the study and divided into the elderly (≥75 years) and non-elderly (<75 years) groups. The background was adjusted by propensity score matching. The short- and long-term outcomes were then compared between the two groups. Results: : There was no difference in the short-term outcomes between the two groups. The elderly group had significantly lower overall survival (OS) and relapse-free survival (RFS) than the non-elderly group. When pulmonary complications occurred, the OS and RFS were significantly decreased in the elderly group but not in the non-elderly group. Without pulmonary complications, the OS and RFS in the elderly group did not differ from those in the non-elderly group. The multivariate analysis showed that pulmonary complications were independent poor prognostic factors for OS and RFS in the elderly group but not in the non-elderly group. Conclusion: Minimally invasive esophagectomy is safe and feasible for older patients. However, the OS and RFS of the elderly group were significantly worse than those of the non-elderly group, especially when pulmonary complications occurred. Therefore, perioperative management to prevent pulmonary complications is essential to improve the long-term outcomes of older patients receiving TE.