Association of age and survival in patients with gastroesophageal cancer undergoing surgery with or without preoperative therapy

BACKGROUND: Meticulous selection of patients for esophageal cancer surgery is critical, because major surgical intervention can cause considerable consequences. For this study, the authors explored their institution's large surgical experience to examine the impact of age on long-term patient survival and surgical complications. METHOD: Six hundred consecutive patients with esophageal cancer who underwent surgery (409 patients received preoperative therapy, and 191 patients underwent surgery first) were analyzed. All demographic information (including American Society of Anesthesiology risk scores) and therapy-related information was collected retrospectively. Multiple statistical methods were used to assess survival rates and surgical complications and their correlation with patient age. Twenty-one patients (30-day mortality) first were excluded (n = 600) and then were included (n = 621) in the analysis. RESULTS: By using the median age (≤60 years) as the cutoff point and creating 2 subgroups (ages 61 years to 70 years and aged >70 years) in patients older than the median age, univariate analysis demonstrated a higher risk of death with increasing age (P = .019). In multivariate analysis, increasing age was an independent prognosticator of poor overall survival (P = .041). The inclusion of 30-day mortality did not alter the results. Surgical complications were statistically significantly higher in older patients compared with younger patients in the following categories: aspiration pneumonia, adult respiratory distress syndrome, cardiovascular, neurologic, and miscellaneous complications. CONCLUSIONS: The data in this study demonstrated that patients aged ≤60 years who underwent surgery for esophageal cancer achieved the best overall survival and experienced fewer surgical complications than patients aged >70 years. Age was identified as an important variable in the selection of patients for esophageal cancer surgery.