Background: Esophageal cancer occurs predominantly in elderly people. To date, there is no standardized treatment protocol for elderly patients with esophageal cancer. The aim of the present study was to assess the effect of old age (≥80 years) on treatment and outcome of esophageal cancer. Methods: We divided 722 patients who underwent esophagectomy between January 2000 and December 2012 into 4 age groups (<70, ≥70 to <75, ≥75 to <80, and ≥80 years) and analyzed the differences among the groups in treatment strategy (preoperative treatment and surgery) and short- and long-term outcome after esophagectomy. Results: Preoperative chemotherapy was significantly less frequently used for the octogenarians than the other groups. Three-field lymphadenectomy was less frequently used with increasing age. Advanced age tended to be associated with higher frequency of postoperative pulmonary and cardiovascular complications, but not with change in mortality rate, compared with younger patients. The overall survival rate was significantly lower in patients of the group≥75 to <80 and group≥80, compared with group<70 (p = 0.011, p = 0.002). Advanced age, low body mass index, postoperative complications, and pathological stage were independent and significant prognostic factors in elderly patients who underwent esophagectomy. Conclusions: Elderly patients aged 75 years and more, especially octogenarians, showed relatively poor prognosis compared with younger patients partly because they less often received neoadjuvant therapy. Aggressive treatment may be recommended for elderly patients after taking into careful consideration the overall physical condition.
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