Background: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 80 years of age) with esophageal cancer. Methods: A total of 668 patients with thoracic esophageal cancer who underwent an esophagectomy by the transthoracic approach were divided into three groups according to age, namely, groups I (>80 years, n = 16), II (70-79 years, n = 158), and III (≤69 years, n = 494). In group I, surgery was only done in patients with PS 0 or 1, as well as normal cardiac and pulmonary functions. Results: The incidence of preoperative pulmonary risk was 16% and 7% in groups II and III, respectively (P < 0.01). The morbidity rates of group II and III were 42% and 32%, respectively (P < 0.05). Pulmonary complications occurred in 18% and 10%, respectively, and cardiovascular complications occurred in 11% and 4%, respectively (P < 0.01). In group I, the morbidity and 30-day mortality rates were 25% and 0%, respectively, and pulmonary and cardiovascular complications occurred only in one patient each (6%). No significant differences were observed in cause-specific survival. Conclusions: In the elderly, preoperative pulmonary risk is frequently present, and careful perioperative management is needed while paying special attention to pulmonary and cardiovascular complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 80 years of age and older without any increased morbidity or mortality.
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