P37 LIMITED MEDIASTINAL LYMPHADENECTOMY FOR ELDERLY PATIENTS OVER 75 YEARS OLD WITH THORACIC ESOPHAGEAL CARCINOMA IS PERMISSIBLE

Abstract Aim The aim of this study is to investigate the influence on postoperative complications and survival rate by the difference in the number of mediastinal lymph node dissection for elderly patients over 75 years old with thoracic esophageal carcinoma. Background & Methods In esophagectomy for thoracic esophageal carcinoma, mediastinal lymphadenectomy is an essential procedure for the radical cure and also an invasive procedure. In elderly patients, especially, the postoperative complications are likely to be serious, and less-invasive surgical procedure is preferred. We sometimes perform limited mediastinal lymphadenectomy for elderly patients with thoracic esophageal carcinoma depending on the case, but the influence on survival rate is controversial. 55 patients who underwent esophagectomy for thoracic esophageal carcinoma over 75 years old between 2007 and 2015 were included in this study. Patients were divided into two groups by number of mediastinal lymph node dissection: normal group (15 or more: n=28) and limited group (less than 15: n=27). The short- and long-term outcomes were retrospectively examined to those groups. Results The median age of the normal and limited group were 76.5 and 79, respectively. No significant differences were demonstrated in clinical stage, operation time and estimated blood loss between these groups. The incidences of postoperative circulatory complications were 37.0% in the normal group and 25.0% in the limited group, but there was no statistically significant difference (P = 0.43). In the normal group, the postoperative respiratory complications (46.4 vs. 14.8%, P = 0.011) and recurrent laryngeal nerve paralysis (21.4 vs. 3.7%, P = 0.049) were significantly higher than that of the limited group. The 5-year overall survival rate (OS) and the 5-year relapse free survival rate (RFS) did not show statistical differences between the normal and limited group (OS: 45.0 vs. 46.0%, P = 0.44; RFS: 39.7 vs. 37.7%, P = 0.57). Conclusion In the limited mediastinal lymphadenectomy group, the postoperative respiratory complications and recurrent laryngeal nerve paralysis have a low occurrence rate. There was no difference in the survival rate between these groups. It was considered that limited mediastinal lymphadenectomy for elderly patients with thoracic esophageal carcinoma is permissible to prevent postoperative complications.