Surgical treatment for carcinoma of the esophagus in the elderly patient.
Sixty-three elderly patients with carcinoma of the esophagus were operated upon in the department of chest cancer in Tianjin Cancer Hospital from January 1978 to January 1992. Eleven patients had a tumor located in the upper part of the thoracic esophagus; 30 patients in the middle part and 22 patients in the lower part. Squamous cell carcinoma was 55 cases, adenocarcinoma was 7 cases and small cell carcinoma was 1 case. The classification by stages according to criteria established by UICC, based on operative evaluation, showed 3 patients in stage I; 24 patients in stage II and 25 patients in stage III. Forty-seven patients were operated as "curative" resection, 5 patients as "palliative" resection and 11 patients underwent exploratory laparotomy or thoracotomy alone. The total resection rate was 82.5%. For tumors in the upper thoracic part of the esophagus, a total esophagectomy was performed using the triple approach. In the remaining patients, a subtotal esophagectomy was performed using the Sweet technique. There were no operative deaths in all patients. One or more postoperative complications were seen in 16 patients (25.4%). The most frequently recorded complications were pulmonary ones. The survival rate at two, three and five years were respectively 65, 35 and 20% in patients who underwent "curative" resection. The survival rates for patients in whom resection was considered "palliative" was zero after 3 years and for patients who received exploration alone was zero after one year. The survival rates at 3 years for patients who underwent "curative" resection were respectively 100, 35 and 25% in stage I, stage II and staged III. We hold the view that the esophagectomy is still a predominant measure for esophageal carcinoma in the elderly and limited surgery (palliative resection) was recommended in consideration of the postoperative quality of life. If the elderly can tolerate the operative procedure, long-term survival with excellent functional status is attainable in this age group.