I agree with the authors that risk assessment for esophagectomy and an accurate selection of patients undergoing surgery, along with multidisciplinary peri-.
Letter to the Editor
To the Editor: I have read with interest the monographic issue of Cancer Control on esophageal cancer. The manuscript with a review of the literature on the impact of age on morbidity and mortality following esophagectomy for cancer is very well done and comes to the relevant conclusion that “elderly patients in good physical condition can tolerate optimal management approaches for esophageal cancer.”1 In our experience, advanced age is not associated with adverse outcomes after esophagectomy for cancer.2-4 High-volume esophageal cancer centers frequently report that 30-day and in-hospital mortality rates are less than 5%.5 Also in our experience, the mortality rate of elderly patients following esophagectomy for cancer is actually less than 3%.2 In this respect, I must highlight and underline that in Table 2 of this article, our data are reported incorrectly.1 Table 2 erroneously reports the number of patients who died rather than the mortality rates: in patients < 70 years of age, 30day and in-hospital mortality rates are 1.9% (11/580) and 2.7% (16/580), respectively, and in patients ≥ 70 years of age, both 30-day and in-hospital mortality rates are 1.9% (3/159). The correct data are included in the Table below.
I agree with the authors that risk assessment for esophagectomy and an accurate selection of patients undergoing surgery, along with multidisciplinary perioperative management, a high-volume environment and surgeon-specific techniques, might be significant contributors to good outcomes in elderly patients following esophagectomy for cancer. Alberto Ruol, MD Chief, Upper GI Surgery Unit. Clinica Chirurgica 3 Department of Surgical Oncological and Gastroenterological Sciences University of Padova. Padova, Italy Disclosures: I have no financial relationship or affiliation to disclose.
References 1. McLoughlin JM, Lewis JM, Meredith KL. The impact of age on morbidity and mortality following esophagectomy for esophageal cancer. Cancer Control. 2013;20(2):144-150. 2. Ruol A, Portale G, Zaninotto G, et al. Results of esophagectomy for esophageal cancer in elderly patients: age has little influence on outcome and survival. J Thorac Cardiovasc Surg. 2007;133(5):1186-1192. 3. Ruol A, Portale G, Castoro C, et al. Management of esophageal cancer in patients aged over 80 years. Eur J Cardiothorac Surg. 2007;32(3):445-448. 4. Ruol A, Portale G, Castoro C, et al. Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer. Ann Surg Oncol. 2007;14(11):3243-3250. 5. Ruol A, Castoro C, Portale G, et al. Trends in management and prognosis for esophageal cancer surgery. twenty-five years of experience at a single institution. Arch Surg. 2009;144(3):247-254.
Table. — Advanced Age is Not a Predictor of Esophagectomy Outcomes
238 Cancer Control
Author
Age (yrs)
No. of Patients
Morbidity (%)
30-day Mortality Rate (%)
In-Hospital Mortality Rate (%)
Overall Survival Rate (%)
Ruol40
≥ 70
165
49.1
1.9
1.9
35.4
< 70
599
48.6
1.9
2.7
33.6
July 2013, Vol. 20, No. 3
