Esophageal cancer treatment in elderly patients: an inconvenient truth

Jeroen C. Hol, Joos Heisterkamp, Ingrid S. Martijnse, Robert A. Matthijsen, Barbara S. Langenhoff


We congratulate Yip, Kikuchi and Peng and their colleagues for providing their useful insights into the important topic of minimally invasive esophagectomy in elderly patients. Multiple studies show that esophageal cancer surgery in elderly patients is associated with high rates of postoperative morbidity and mortality (1,2). However, by focusing on postoperative outcomes, there is an inconvenient truth that has been concealed: the significance of the underlying disease that is often not reported in studies. Although steps have been made in the past decades to improve survival, the long-term outcome of locally advanced esophageal cancer remains poor (3). Surgical resection is the cornerstone of curative treatment. However, it is associated with significant morbidity and mortality. The question is: do we unnecessarily deprive patients of treatments that may improve survival? Second: can we select the best pathway for the individual patient?