Comment on “Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5066 Patients in the National Database of Hospital-based Cancer Registries in Japan” : Annals of Surgery Open

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Letter to the Editor

Comment on “Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5066 Patients in the National Database of Hospital-based Cancer Registries in Japan”

Akkapulu, Nezih MD, FACS

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doi: 10.1097/AS9.0000000000000204
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To the Editor,

I read Motoyama et al’s article1 with great interest. The authors revealed that the 3-year survival rate was higher in the ≥75 group than in the octogenarian group. The article concluded that many octogenarians have no survival advantages from an esophagectomy for this reason; they should be evaluated based on not only age but also overall medical status for deciding to perform esophagectomy.

Some points should be considered while evaluating the result.

As mentioned in the article, frailty should be assessed preoperatively, but there is no universally accepted tool to evaluate frailty. Frailty and comorbidity are crucial factors affecting oncological and survival outcomes in elderly patients undergoing oncological surgery.2,3 However, the study did not present any determinants of frailty, such as body mass index and weakness or comorbidity status in the study population.

Another and more important concern is that surgery-related morbidity did not show in the article. As it is known, postoperative complications directly affect survival outcomes.4 Standardized postoperative complications classification of patients could have been compared between the groups

The lack of these 2 critical points is an essential limitation of the study, and I believe that it should have been mentioned in the article.

REFERENCES

1. Motoyama S, Maeda E, Iijima K, et al. Does esophagectomy provide a survival advantage to patients aged 80 years or older? Analyzing 5066 patients in the national database of hospital-based cancer registries in Japan. Ann Surg. 2022;276:e16–e23.
2. Davey MG, Joyce WP. Impact of frailty on oncological outcomes in patients undergoing surgery for colorectal cancer—a systematic review and meta-analysis [published online ahead of print]. Surgeon. 2022.
3. Lim YK, Jackson C, Dauway EL, et al. Risk factors for adverse outcome for elderly patients undergoing curative oncological resection for gastrointestinal malignancies. Visc Med. 2017;33:254–261.
4. Wang HW, Jin KM, Li J, et al. Post-operative complications predict poor outcomes only in patients with a low modified clinical score after resection of colorectal liver metastases: a retrospective cohort study [published online ahead of print]. Updates Surg. 2022.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.