LAUSR

Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated. We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups. There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥  grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively. MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease. All authors have declared no conflicts of interest.