• Esophagogastric cancer
• Health-related quality of life
• Survival

• elderly
• head and neck cancer
• prognosis
• surgery
• survival

• Adjuvant chemotherapy
• Gastric cancer
• Nomogram
• Overall survival
• Prediction

This study aims to investigate the prognostic factors affecting survival in patients undergoing surgical treatment for esophageal cancer.

A total of 50 patients (33 males, 17 females; mean age: 57.8±11.8 years; range, 28 to 80 years) who underwent esophagectomy for esophageal cancer in our clinic between January 2008 and March 2018 were retrospectively analyzed. Prognostic factors affecting survival were investigated. Data including age, sex, tumor size, histological and macroscopic type, tumor stage, T and N categories, the total number of resected lymph nodes and metastatic lymph node ratio, differentiation degree, vascular and perineural invasion, proximal surgical margin distance, adjuvant therapy, and the presence of postoperative complications were recorded.

The patients after radical surgery with a tumor size of <3 cm, macroscopic type non-ulcerative-infiltrative squamous cell carcinoma pathology, Stage 1 disease, pT1-2, pN0, well-differentiated groups, no perineural invasion, a metastatic lymph node ratio of <0.2, proximal surgery margin length of 5 to 10 cm, and no postoperative complications had higher five-year survival rates. However, when the effects of these factors on overall survival were examined independently, none of them had a statistically significant effect (p>0.05). The main factors affecting the prognosis were Stage ≥2 disease, postoperative complications, and proximal surgical margin less than 5 cm.

Our study results suggest that Stage 1 disease, a proximal surgical margin length of more than 5 cm, and the absence of complications are associated with longer survival times and these patients are greatly benefited from surgical treatment.

• Esophageal cancer
• esophagectomy
• prognostic factors
• surgery

The number of elderly patients diagnosed with esophageal cancer rises. Current information about outcomes in elderly patients undergoing thoracoscopic Ivor Lewis esophagectomy is limited. The objective of this study was to evaluate the influence of age on short-and mid-term outcomes after thoracoscopic Ivor Lewis esophagectomy.

A retrospective review of 188 patients with esophageal cancer undergoing thoracoscopic Ivor Lewis esophagectomy between August 2014 and July 2019 was performed. Patients were divided into patients aged > 75 years (elderly group (EG), n = 37) and patients ≤ 75 years (younger group (YG), n = 151) and matched using propensity-score matching. Baseline characteristics, length of hospital stay, mortality and major postoperative complications (Clavien-Dindo ≥ grade III) were compared.

After matching 74 patients remained (n = 37 in each group). Postoperatively, no significant differences in major and overall complications, intra-hospital and 30-day mortality, disease-free or overall survival up to 3 years after surgery were noted. The incidence of pulmonary complications (65% vs. 38%) and pneumonia (54% vs. 30%) was significantly higher and the median hospital length of stay (12 vs. 14 days) significantly longer in the EG versus YG.

Thoracoscopic Ivor Lewis esophagectomies resulted in acceptable postoperative major morbidity and mortality without compromising 3-years overall and disease-free survival in elderly compared to younger patients with esophageal cancer. However, the incidence of postoperative pulmonary complications was higher in patients aged over 75 years.

The online version contains supplementary material available at 10.1186/s12893-021-01435-5.

• Age
• Esophageal cancer
• Ivor Lewis
• Outcome
• Thoracoscopic esophagectomy

• gastrointestinal
• morbidity
• outcomes
• prehabilitation
• rehabilitation
• risk assessment
• surgery

Colorectal cancer (CRC) is the third most common cancer worldwide. As with many other cancers, the risk for CRC increases with age. This is also true for comorbidities, which may hamper sufficient treatment of the cancer. Due to restrictive inclusion criteria, older patients and patients with comorbidities are underrepresented in clinical trials. Comprehensive knowledge about modern effectiveness of oncological treatments in older and/or comorbid patients is sparse. Due to the lack of clinical trials, this issue is investigated in real-life settings predominantly. In our retrospective study we show that patients benefit from oncological treatments irrespective of comorbidities, measured by the age-adjusted Charlson Comorbity (aaCCI) index, and age. Differences found in treatment outcomes are marginal and are likely due to less intense treatment of comorbid or elderly patients. Balancing risk and benefit for treatment decisions should take potential under-treatment of comorbid and older patients into account.

We aimed to investigate the effectiveness of oncological treatments in metastatic CRC related to comorbidities and age. This retrospective study included 1105 patients from three oncological centers. aaCCI and CCI was available from 577 patients. An aaCCI > 3 was of the highest predictive value compared to other aaCCI-levels, CCI or age (p < 0.001 for all). Treatment (best supportive care (BSC), systemic treatment only (STO) and resection of metastases (ROM)) significantly prolonged survival in patients with aaCCI > 3 (STO: HR 0.39, CI 0.29–0.51; ROM: HR 0.16, CI 0.10–0.24) and patients older than 70 years (STO: HR 0.56, CI 0.47–0.66; ROM: HR 0.23, 0.18–0.30). Median overall survival was shorter in patients with aaCCI or age > 70 years and interaction for treatment type not significant for aaCCI, but significant for age older or younger than 70 years (STO: p = 0.01; ROM p = 0.02). BSC is more often considered as optimal care for patients with an aaCCI > 3 (37.6% vs. 12.4%; p < 0.001) or age > 70 years (35.7% vs. 11.2%; p < 0.001). Older patients or patients with comorbidities benefit from cancer-specific therapy independently of their age and comorbidities.

• colorectal cancer
• comorbidities
• elderly
• metastases
• real-life
• treatment

Intensity-modulated radiotherapy (IMRT) can improve the prognosis of patients with esophageal cancer. This study aimed to evaluate clinical factors relevant to the prognosis of patients with esophageal cancer who received intensity-modulated radiotherapy (IMRT) alone.

Data of 103 patients with pathologically confirmed esophageal cancer who were admitted to our hospital between October 2011 and November 2017 were retrospectively reviewed. All patients had squamous cell carcinoma. All patients received IMRT. Patients with stage I–IVA tumors were included to represent the real-world clinical practice. We performed univariate and multivariate analyses to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). In univariate analyses, the Kaplan–Meier method was used to estimate OS and PFS for various subgroups. In multivariate analyses, hazard ratios were calculated.

Single-factor analysis revealed that T stage (P=0.019), N stage (P =0.047), and lesion length (P =0.000) were associated with the prognosis of esophageal cancer patients who received IMRT. Cox regression analysis revealed that T stage (odds ratio [OR] = 4.68; P < 0.05), N stage (OR = 0.28; P < 0.05), and lesion length (OR = 0.09; P < 0.05) were independent factors relevant to prognosis.

T stage, N stage, and lesion length influenced the long-term curative effects of IMRT for esophageal cancer and were prognostic factors for patients with esophageal cancer receiving definitive radiotherapy alone. The higher the stage and the longer the tumor, the lower the survival rate.

• esophageal neoplasms
• intensity-modulated radiotherapy
• prognosis
• retrospective studies

• Chemoradiation
• Esophageal cancer
• IMRT
• Simultaneous integrated boost

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemoradiotherapy/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/therapy
• Esophageal Squamous Cell Carcinoma/pathology
• Esophageal Squamous Cell Carcinoma/therapy
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/therapy
• Prognosis
• Radiotherapy, Intensity-Modulated/mortality
• Retrospective Studies
• Survival Rate

• Projekt DEAL

• Cause-specific survival
• Gastric cancer
• Modified age-adjusted Charlson comorbidity index

• age
• carcinoma oesophagus
• oesophagectomy

• Age
• Chemotherapy
• Gastric cancer
• Oesophageal cancer
• Sex
• Survival

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols/pharmacology
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/mortality
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Sex Factors
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/mortality
• Survival Rate
• Young Adult

• 15499 Cancer Research UK
• 16251 Cancer Research UK
• 6410 Cancer Research UK
• MC_UU_12023/20 Medical Research Council

Japan is facing an aging society. Elderly individuals are generally more prone to comorbidities and have weaker immune defenses, with ominous prognostic implications if postoperative complications arise. The aim of this study was to explore scoring systems for predicting postoperative morbidity risk in super elderly patients (≥85 years old) after colorectal surgery for cancer.

A population of elderly patients (n = 145) surgically treated for primary colorectal cancer within our department between April 2007 and December 2018 was examined retrospectively, assessing the capacities of various indices, such as Estimation of Physiologic Ability and Surgical Stress (E-PASS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), and modified Glasgow Prognostic Score (mGPS), to predict postoperative complications.

NLR, PLR, and mGPS did not differ significantly in the presence or absence of complications, whereas PNI tended to be lower if complications developed. The E-PASS system showed no group-wise differences in preoperative risk score (PRS), but the surgical stress score (SSS) and the comprehensive risk score (CRS; a composite of PRS and SSS) was significantly higher in patients with complications. Based on the cutoff value calculated from the Receiver operating curve (ROC) for the E-PASS CRS (−0.0580), patients were stratified into low-scoring and high-scoring (HSG) groups. Although not significantly different, the overall survival in the HSG tended to be lower by comparison.

The E-PASS scoring system may be a useful predictor of postoperative complications in super elderly patients requiring colorectal cancer surgery.

• colorectal cancer
• elderly
• postoperative complications
• prognostic scoring

• esophageal and gastric cancer
• esophageal and gastric surgery
• hepatic surgery
• metastasis
• pulmonary surgery

Whether we can increase the resection rate of esophageal cancer by minimally invasive esophagectomy (MIE) is unknown. The aim was to report the number and results of MIE in high-risk patients considered unsuitable for open surgery and compare these results to other operated patients and to high-risk patients not undergoing surgery.

At Central Finland Central Hospital, between September 2012 and July 2018, the number of operated MIEs was 100. Of these, 10 patients were prospectively considered unfit for open approach. Nineteen additional high-risk patients with operable disease were ruled out of surgery. The short- and long-term outcomes of these 3 groups were compared.

In patients eligible for any approach (n=90), MIE only (n=10), and no surgery (n=19), WHO performance status Grade 0 was observed in 66.7%, 20.0%, and 5.3%, respectively; stair climbing with ≥4 stairs was successfully completed in 77.8%, 50%, and 36.8%, respectively. Between any approach and MIE only groups, rate of major complications (Clavien-Dindo ≥3a) was 6.7% vs. 50.0% (p<0.001) without a difference in median hospital stay (9 vs. 10 days, p=0.542). Readmission rates were 4.4% vs. 30.0% (p=0.003). Survival rates were 100% vs. 80% (p<0.001) at 90-days, 91.5% vs. 66.7% (p=0.005) at 1-year, and 68.9% vs. 53.3% (p=0.024) at 3-years, respectively. In comparison between MIE only and no surgery groups, these survival rates from day of diagnosis were 80% vs. 100%, 68.6% vs. 67.1%, and 45.7% vs. 32.0% (p=0.290), respectively.

By operating patients unsuitable for open approach with MIE, the resection rate increased 11.1%. These high-risk patients had, however, higher early morbidity and reduced long-term survival compared to other operated patients. Though there seems to be long-term benefit of surgery compared to nonsurgical patients, we have to be cautious when offering surgery to those considered unfit for open surgery.

This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery.

In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan–Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS).

A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72–15.58; and OR 3.09; 95% CI 1.93–4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97–7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57–6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78–2.97; and HR 0.73; 95% CI 0.13–4.14).

Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.

• Aged
• Esophageal neoplasms
• Esophagectomy
• Mortality
• Postoperative complications

• Radboud University Medical Center

• administrative claims data
• comorbidity
• medical record linkage
• neoplasms
• survival analysis

• Age
• Prognosis
• Solid cancer
• Surgical resection

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasms/mortality
• Neoplasms/surgery
• Prognosis
• Survival Analysis
• Taiwan/epidemiology

• advance care planning
• decision support tools
• human-centred design
• patient- and family-centred care
• surgery

• Audit
• Cancer centre
• Cancer unit
• Care pathways
• Essential requirements
• Europe
• Gastric cancer
• Guidelines
• Health inequalities
• Healthcare system
• Multidisciplinary
• Multidisciplinary team
• Oesophageal cancer
• Oesophageal-gastric cancer
• Organisation of care
• Patient information
• Patient-centred
• Quality
• Quality assurance
• Stomach cancer

• AKT
• Esopageal cancer
• Predictiv factors
• Radiochemotherapy
• Small heat shock protein

• Cancer registry
• Colorectal cancer
• Elderly
• Gastric cancer
• Oesophageal cancer

• Adult palliative care
• advance care planning
• patient-centered outcomes research
• video tools

• Adolescent
• Adult
• Advance Care Planning
• Aged
• Clinical Protocols
• Communication
• Decision Support Techniques
• Female
• Humans
• Male
• Maryland
• Middle Aged
• Neoplasms/psychology
• Neoplasms/surgery
• Patient Participation
• Perioperative Period
• Video Recording/statistics & numerical data
• Young Adult

• CD-12-11-4362 Patient-Centered Outcomes Research Institute

• Oesophageal cancer
• Oesophagectomy

Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient. This study aims to discuss the recent trends in palliation of dysphagia with promising results and the most suitable therapy for palliation of dysphagia in a given patient. A total of 64 articles that were published between years 2005 and 2015 on various modes of palliation of dysphagia in carcinoma esophagus were studied, which were mainly randomized and prospective studies. Through this study, we conclude that stents are the first choice of therapy for palliation, which is safe and cost-effective, and they can be combined with either radiotherapy or chemotherapy for long-term palliation of dysphagia with good quality of life. Radiotherapy can be used as a second-line treatment modality.

• carcinoma esophagus
• esophageal stents
• palliation
• radiotherapy

• gastric cancer
• second-line chemotherapy
• supportive care
• meta-analysis
• patient-level data
• age

• Adenocarcinoma/drug therapy
• Adenocarcinoma/therapy
• Aged
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/therapy
• Esophagogastric Junction/pathology
• Female
• Humans
• Male
• Middle Aged
• Randomized Controlled Trials as Topic

• Wellcome Trust

• Distal gastrectomy
• Gastric cancer
• Long-term survival
• Morbidity
• Mortality

Context: Appropriate selection of aging patient who fit for cancer surgery is an art-of-state.

Objectives: This study aimed to identify predictive factors pertinent to 3-month postoperative mortality in geriatric cancer patients.

Methods: A total of 8,425 patients over 70 years old with solid cancer received radical surgery between 2007 and 2012 at four affiliated hospitals of the Chang Gung Memorial Hospital were included. The clinical variables of patients who died within 3 months post-surgery were analyzed retrospectively. Recursive partitioning analysis (RPA) was performed by randomly selecting 50% of the patients (testing set) to identify specific groups of patients with the lowest and highest probability of 3-month postoperative mortality. The remaining 50% were used as validation set of the model.

Results: Patients' gender, Eastern Cooperative Oncology Group performance (ECOG scale), Charlson comorbidity index (CCI), American Society of Anesthesiologist physical status, age, tumor staging, and mode of admission were independent variables that predicted 3-month postoperative mortality. The RPA model identified patients with an ECOG scale of 0-2, localized tumor stage, and a CCI of 0-2 as having the lowest probability of 3-month postoperative mortality (1.1% and 1.3% in the testing set and validation set, respectively). Conversely, an ECOG scale of 3-4 and a CCI >2 were associated with the highest probability of 3-month postoperative mortality (55.2% and 47.8% in the testing set and validation set, respectively).

Conclusion: We identified ECOG scale and CCI score were the two most influencing factors that determined 3-month postoperative mortality in geriatric cancer patients.

• geriatric patients
• postoperative mortality
• predictive factors
• solid cancer

Oesophagectomy for cancer could be safe and worthwhile in selected older patients, but less is known about the effect of oesophagectomy on perceived quality of life of such delicate class of cancer patients. The aim of this study was to evaluate the impact of oesophagectomy for cancer in elderly patients in term of health-related quality of life.

We retrospectively evaluated all consecutive patients who underwent oesophagectomy for cancer at the Surgical Oncology Unit of the Veneto Institute of Oncology between November 2009 and March 2014. Quality of life was evaluated using EORTC C-30 and OES-18 questionnaires at admission, at discharge and 3 months after surgery. Adjusted multivariable linear mixed effect models were estimated to assess mean score differences (MDs) of selected aspects in older (≥70 years) and younger (<70 years) patients.

Among 109 participating patients, 23 (21.1 %) were at least 70 years old and 86 (78.9 %) were younger than 70 years. Global quality of life was clinically similar between older and younger patients over time (MD 4.4). Older patients reported clinically and statistically significantly worse swallowing saliva (MD 17.4, 95 % C.I. 3.6 to 31.2), choking when swallowing (MD 13.8, 95 % C.I. 5.8 to 21.8) and eating difficulties (MD 20.1 95 % C.I. 7.4 to 32.8) than younger patients only at admission.

Early health-related quality of life perception after surgery resulted comparable in older and younger patients. This result may also be due to some predisposition of the elderly to adapt to the new status.

The online version of this article (doi:10.1186/s12885-015-1647-5) contains supplementary material, which is available to authorized users.

• definitive chemo-radiation
• esophageal cancer
• prognostic factors
• radiotherapy
• toxicity

• Age Distribution
• Aged
• Chemoradiotherapy/mortality
• Chemoradiotherapy/statistics & numerical data
• Disease-Free Survival
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/therapy
• Female
• Germany/epidemiology
• Humans
• Incidence
• Male
• Middle Aged
• Neoplasm Recurrence, Local/diagnosis
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/therapy
• Prognosis
• Radiation Injuries/epidemiology
• Radiotherapy, Conformal/mortality
• Retrospective Studies
• Risk Factors
• Sex Distribution
• Survival Rate
• Treatment Outcome