P1.183. Salvage Surgery and Conversion Surgery for Esophageal Cancer in Patients Aged 80 Years or Older

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background With the rapid aging of the population, esophageal cancer in individuals aged 80 and older continues to increase. Conversely, with recent advances in multidisciplinary treatment, including novel chemotherapies and immune checkpoint inhibitors, “salvage surgery” and “conversion surgery” are increasingly being performed. These procedures often involve more invasive techniques than standard approaches, and their applicability in the elderly remains uncertain. We conducted this study to clarify the outcomes of salvage and conversion surgery for esophageal cancer in patients aged 80 years or older. Methods Among 768 esophageal cancer surgeries performed at our institution from April 2012 to December 2023, 97 cases (12.7%) involved patients aged 80 years or older. Among these, salvage surgery with radical chemoradiotherapy was performed in 7 cases (14%), with one case also receiving immune checkpoint inhibitor (ICI) therapy. All patients were male, aged 81-85 years. Pre-treatment clinical stages were I/II/III/IV: 1/0/4/2. Two cases underwent conversion surgery where the tumor was downstaged from unresectable status preoperatively (unresectable factors: tracheal invasion in 1 case, abdominal lymph node metastasis with extranodal invasion in 1 case). These cases were retrospectively reviewed. Results our patients underwent thoracoscopic esophagectomy, two underwent right thoracotomy esophagectomy, and one underwent open esophagogastric anastomosis. No residual disease was left intraoperatively. Grade II or higher C-D classification complications occurred in 3 cases (43%). There were no in-hospital deaths. The postoperative hospital stay ranged from 15 to 165 days, with a median of 27 days. Recurrence occurred in 2 cases (1 after conversion surgery). One case required home oxygen therapy. Conclusion Conversion surgery in patients aged 80 years or older with esophageal cancer was performed in only a small number of cases. The overall outcomes of salvage surgery were relatively favorable. As the number of ICI-treated cases increases in the future, conversion surgery in elderly patients is likely to become more common. It is important to gain experience with salvage surgery, conversion surgery, surgery after ICI treatment, and standard multidisciplinary treatment for elderly patients, and to establish conversion surgery for this population.