• Aging
• Epidemiology
• Outcomes
• Therapy

• Humans
• Neoplasms/epidemiology
• Neoplasms/therapy
• Aged
• Age Factors
• Aged, 80 and over
• Middle Aged
• United States/epidemiology

• Project n°16731054 SP is supported by the Luxembourg National Research Fund (FNR)
• University of Zurich

• neoadjuvant chemoradiotherapy
• neoadjuvant chemotherapy
• oesophagectomy
• perioperative outcomes
• up‐front surgery

• Humans
• Esophageal Neoplasms/therapy
• Esophageal Neoplasms/mortality
• Male
• Female
• Esophagectomy
• Neoadjuvant Therapy/methods
• Retrospective Studies
• Middle Aged
• Aged
• Postoperative Complications/epidemiology
• Treatment Outcome
• Chemoradiotherapy/methods
• Length of Stay/statistics & numerical data

• Aged
• Humans
• Retrospective Studies
• Stomach Neoplasms/complications
• Esophageal Neoplasms
• Esophagectomy/adverse effects
• Postoperative Complications/etiology
• Gastrectomy/adverse effects

• University of Sydney

• Cancer
• HRQL
• Health-related quality of life
• NT
• Neoadjuvant chemoradiotherapy
• Neoadjuvant chemotherapy
• Neoadjuvant therapy
• Oesophagus
• Preoperative
• Stomach
• nCRT
• nCT

• Humans
• Neoadjuvant Therapy/methods
• Quality of Life
• Treatment Outcome
• Cohort Studies
• Esophageal Neoplasms
• Stomach Neoplasms/drug therapy
• Chemoradiotherapy

• complications
• esophageal cancers
• minimal invasive esophagectomy
• transhiatal esophagectomy

The optimal treatment for elderly patients with esophageal cancer (EC) remains controversial. In the present study, we aimed to investigate whether elderly patients with stage II–III EC could benefit from trimodal therapy.

The selected elderly patients with stage II–III EC between 2004 and 2015 were included in a retrospective cohort study from the Surveillance, Epidemiology, and End Results database. The patients were divided into two groups based on whether or not they underwent surgery. The inverse probability of treatment weighting (IPTW) analysis was used to balance the confounding factors between the two groups. The Cox regression analysis, the log‐rank test, and the Kaplan–Meier curves were conducted to identify the survival benefits of different treatment regimes.

A total of 1596 patients were included in this cohort study, in which 278 patients underwent surgery. In the combination of chemoradiotherapy and surgery group, there were more male patients, more patients aged between 75 and 79 years, and more married patients in the surgery group. Moreover, there were more patients with adenomatous carcinoma, more patients with a tumor size of less than 5 cm, and more patients with a T3 stage in the combination group. In the survival analysis, patients in the combination group had a longer overall survival (OS) and EC‐specific survival (ECSS). After IPTW analysis, the survival analysis generated similar results. The competitive risk model found that our results were stable. There was still a significant difference in OS and ECSS between the combination group and chemoradiotherapy alone group for esophageal adenocarcinoma (p < 0.001).

Elderly patients with stage II–III EC, especially those with adenocarcinoma, could benefit from the combination of surgery and chemoradiotherapy.

• chemoradiotherapy
• elderly patients
• esophageal cancer
• surgery
• survival

Any given treatment may provide improve survival for elderly patients with oesophageal cancer compared to best supportive care. Although surgery may be related to a higher rate of complications in these patients, it also offers the best chance for survival, especially when combined with perioperative chemo-or chemoradiation. Definitive chemoradiation remains also a valid and widely used curative approach in this population. Quality of life after oesophageal cancer treatment does not seem to be particularly compromised in elderly patients, although the risk of loss of autonomy after the disease is higher. Based on the available data, excluding a priori elderly patients from curative treatment based on age alone cannot be supported. A thorough general health status and geriatric assessment is necessary to offer the optimal treatment, tailored to the individual patient.

Esophageal cancer, despite its tendency to increase among younger patients, remains a disease of the elderly, with the peak incidence between 70–79 years. In spite of that, elderly patients are still excluded from major clinical trials and they are frequently offered suboptimal treatment even for curable stages of the disease. In this review, a clear survival benefit is demonstrated for elderly patients treated with neoadjuvant treatment, surgery, and even definitive chemoradiation compared to palliative or no treatment. Surgery in elderly patients is often associated with higher morbidity and mortality compared to younger patients and may put older frail patients at increased risk of autonomy loss. Definitive chemoradiation is the predominant modality offered to elderly patients, with very promising results especially for squamous cell cancer, although higher rates of acute toxicity might be encountered. Based on the all the above, and although the best available evidence comes from retrospective studies, it is not justified to refrain from curative treatment for elderly patients based on their age alone. Thorough assessment and an adapted treatment plan as well as inclusion of elderly patients in ongoing clinical trials will allow better understanding and management of esophageal cancer in this heterogeneous and often frail population.

• definitive chemoradiation
• elderly
• esophageal cancer
• esophagectomy
• surgery

An increasing number of older patients is undergoing curative, surgical treatment of esophageal cancer. Previous meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients, which may lead to patient selection based on age. However, only studies including patients that underwent open esophagectomy were included. Therefore, it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive esophagectomy.

To perform a systematic review on age and postoperative outcome in esophageal cancer patients undergoing esophagectomy.

Studies comparing older with younger patients with primary esophageal cancer undergoing curative esophagectomy were included. Meta-analysis of studies using a 75-year age threshold are presented in the manuscript, studies using other age thresholds in the Supplementary material. MEDLINE, Embase and the Cochrane Library were searched for articles published between 1995 and 2020. Risk of bias was assessed with the Newcastle-Ottawa Scale. Primary outcomes were anastomotic leak, pulmonary and cardiac complications, delirium, 30- and 90-d, and in-hospital mortality. Secondary outcomes included pneumonia and 5-year overall survival.

Seven studies (4847 patients) using an age threshold of 75 years were included for meta-analysis with 755 older and 4092 younger patients. Older patients (9.05%) had higher rates of 90-d mortality compared with younger patients (3.92%), (confidence interval = 1.10-5.56). In addition, older patients (9.45%) had higher rates of in-hospital mortality compared with younger patients (3.68%), (confidence interval = 1.01-5.91). In the subgroup of 2 studies with minimally invasive esophagectomy, older and younger patients had comparable 30-d, 90-d and in-hospital mortality rates.

Older patients undergoing curative esophagectomy for esophageal cancer have a higher postoperative mortality risk. Minimally invasive esophagectomy may be important for minimizing mortality in older patients.

• Elderly
• Minimally invasive esophagectomy
• Open esophagectomy
• Esophageal cancer
• Clinical outcome
• Perioperative mortality

• Elderly patients
• Gastric cancer
• Prognostic nutrition index