Esophageal cancer: Outcome and potential benefit of esophagectomy in elderly patients.

BACKGROUND: This analysis evaluated the morbimortality and the potential benefit of esophagectomy for cancer in elderly patients. METHODS: Patients who underwent esophagectomy for EC were divided into elderly (≥70 years) and nonelderly (<70 years) groups. The groups were compared regarding patient and tumor characteristics, postoperative morbimortality, and disease-free, overall and cancer-specific survival. RESULTS: Sixty-one patients were classified into elderly, and 187 into nonelderly groups. The elderly were characterized by a higher rate of WHO score (p < 0.0001), higher cardiac (p < 0.004) and renal (p < 0.023) comorbidities. The rate of neoadjuvant therapy and especially of neoadjuvant CRT was significantly lower in elderly patients (p < 0.018 and p < 0.007). Operative morbidity was also higher in this group (p < 0.024). The 30- and 90-day mortality was 8.2 and 11.5%, respectively in elderly patients and 0.5 and 3.2% in nonelderly patients (p < 0.004 and p < 0.012). This 90-day mortality decreased when specific surgery-related deaths were taken into consideration. OS and DFS were significantly better in the nonelderly group (p < 0.003 and p < 0.005) while no difference was observed for cancer-specific survival (CSS). CONCLUSION: No difference in CSS was observed. Although elderly patients with EC had higher postoperative morbimortality, the age should not be a criterion whether to perform, or not to perform, esophagectomy. This decision must be based on the balance between the patient's general condition and aggressive disease.

Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis.

PURPOSE: To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). MATERIALS AND METHODS: Two hundred and twenty patients who underwent treatment of 353 HCCs were retrospectively reviewed, including 30 NASH patients who received TACE for 46 HCCs. Patient charts were evaluated for time to progression (TTP), complications and overall survival (OS). The group was split into NASH and non-NASH cohorts for comparison and additional analyses were done using propensity score matching (PSM). RESULTS: Patients in the NASH cohort presented with significantly larger lesions (4.9 ± 5.8 cm vs 3.1 ± 2.4 cm, p = 0.05). There was no significant difference in TTP overall [Median NASH 396 days (95% CI 308-526 days) vs non-NASH cohort 307 days (95% CI 272-364), p = 0.25) or after PSM [259 days non-NASH (95% CI 215-490) vs 396 days NASH (95% CI (349-not reached), p = 0.43]. There was a non-significant increased OS in the non-NASH [median 1078 days (95% CI 668-1594)] as compared to the NASH cohort [median 706 days (95% CI 314-not reached)] (p = 0.08) which decreased following PSM [853 days (95% CI 526-1511) non-NASH vs 706 days (95% CI 314-not reached) NASH, p = 0.48]. The number of complications did not differ significantly between the two groups (p = 0.23). CONCLUSION: The oncologic outcomes and complication profile of TACE for HCC induced by NASH cirrhosis appear to be similar to that of other etiologies of cirrhosis. NASH patients presented with larger tumors emphasizing the need for early surveillance.