Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2021; 13(2): 131-146
Published online Feb 15, 2021. doi: 10.4251/wjgo.v13.i2.131
Outcomes of curative esophageal cancer surgery in elderly: A meta-analysis
Nikolaj S Baranov, Cettela Slootmans, Frans van Workum, Bastiaan R Klarenbeek, Yvonne Schoon, Camiel Rosman
Nikolaj S Baranov, Cettela Slootmans, Frans van Workum, Bastiaan R Klarenbeek, Camiel Rosman, Department of Surgery, Radboud University Medical Center, Nijmegen 6525GA, the Netherlands
Yvonne Schoon, Department of Geriatrics, Radboud University Medical Center, Nijmegen 6525GA, the Netherlands
Author contributions: All authors contributed to the design of the work, Baranov NS, Slootmans C and van Workum F were involved in acquisition of the data; analysis was performed by Baranov NS and all other authors were involved in interpretation of the work; Baranov NS and Slootmans C were involved in drafting the manuscript; all other authors were involved in critically revising the manuscript for intellectual content. All authors approve of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Nikolaj S Baranov, BSc, Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10/Postal box 9101, Nijmegen 6525GA, the Netherlands.
Received: September 22, 2020
Peer-review started: September 22, 2020
First decision: November 16, 2020
Revised: November 29, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 15, 2021
Research background

Fit patients diagnosed with cT1-3N0-3M0 (resectable) esophageal cancer generally undergo curative esophagectomy. An increasing number of older patients is undergoing curative esophagectomy for resectable esophageal cancer. Previous meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients.

Research motivation

Increased morbidity and mortality in older patients after esophagectomy may lead to patient selection based on age. However, only studies including patients that underwent open esophagectomy were meta-analyzed. Therefore, it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive esophagectomy.

Research objectives

To perform a systematic review and meta-analysis on age and postoperative outcome in esophageal cancer patients undergoing esophagectomy, including minimally invasive esophagectomy.

Research methods

Studies comparing older with younger patients with primary esophageal cancer undergoing curative esophagectomy were included. Meta-analysis of studies using a 75-year age threshold are presented in the manuscript, studies using other age thresholds in the Supplementary material. MEDLINE, Embase and the Cochrane Library were searched for articles published between 1995 and 2020. Risk of bias was assessed with the Newcastle-Ottawa Scale. Primary outcomes were anastomotic leak, pulmonary and cardiac complications, delirium, 30-and 90-d, and in-hospital mortality. Secondary outcomes included pneumonia and 5-year overall survival.

Research results

Seven studies (4847 patients) using an age threshold of 75 years were included for meta-analysis with 755 older and 4092 younger patients. Older patients (9.05%) had higher rates of 90-d mortality compared with younger patients (3.92%), (confidence interval = 1.10-5.56). In addition, older patients (9.45%) had higher rates of in-hospital mortality compared with younger patients (3.68%), (confidence interval = 1.01-5.91). In the subgroup of 2 studies with minimally invasive esophagectomy, older and younger patients had comparable 30-d, 90-d and in-hospital mortality rates.

Research conclusions

Older patients undergoing curative esophagectomy for esophageal cancer have a higher postoperative mortality risk. Minimally invasive esophagectomy may be important for minimizing mortality in older patients.

Research perspectives

Future studies with more patients are needed to investigate the effects of curative minimally invasive esophagectomy on morbidity, mortality and especially quality of life in older patients with resectable esophageal cancer. Currently, we are investigating this with population-based surgical oncology data from the Netherlands.