Need to consider carefully the elderly esophageal cancer surgery

In recent years, high-aging relative increase in the incidence of esophageal cancer, which is to improve people's standard of living and aging societies hotels specifically catering results. We are generally 60 to 70-year-old said the old age, 70 to 80-year-old said the old, 80 years old, said super-old. Groups of older patients with esophageal cancer high physical, psychological and social life has its own particularities, problems relating to the treatment of esophageal cancer need special discussion. For the high-aged patients with esophageal cancer treatment options should be strictly separated, take seriously the development of appropriate individual treatment programs.

Is well known that surgery with radical and non-bio-resistance of the outstanding advantages. In recent years, high-aging indications for esophageal cancer surgery than before to expand a lot. However, the expansion of surgical indications, so that a corresponding increase in postoperative complications. Surgery within 30 days after death, many in this age group. Operative complications and operative mortality was increased on the one hand and the open-chest hit major operations related to the other hand, in patients with high-Aging esophageal poor physical condition, past history of more complex, often associated with a variety of organs and other related diseases. The more common complications are malnutrition, anemia and diabetes, cardiovascular and cerebrovascular and respiratory diseases, old diseases, abdominal cavity and surgical experience, a potential multi-organ functional status of sub-clinical low, long-term smoking and drinking, psychological and social and family factors would have serious repercussions on the surgery. Even some seemingly ordinary high-aged patients with complications will also become an insurmountable obstacle in life. Common postoperative complications in the lungs has pneumonia, including infections and aspiration pneumonia, atelectasis, pulmonary edema, respiratory failure and so on, there are a variety of cardiovascular atrial or ventricular arrhythmia, hypertension, congestive heart failure, myocardial infarction, pulmonary embolism caused by deep vein embolus shedding, etc. Others include hypoproteinemia, diabetes, caused by anastomosis, wound edema, poor wound healing, severe infections and multiple organ failure and so on.

For the general good physical condition, surgical removal of the possibility and seize a larger, especially in patients with radical resection can be fully prepared before surgery preparations for the surgery. Esophageal cancer surgery to minimize surgical strikes, shorten the operation time. Esophageal cancer after surgery intensive care, full atomization, effective expectoration, encouraging bedside activities. Aging due to the high cardio-pulmonary functional reserve in patients with inadequate, prone to cardio-pulmonary complications after surgery, we must tackle them promptly. Some of esophageal cancer patients, a longer time before admission of esophageal obstruction due to feeding difficulties, poor nutritional status. After admission for nasal feeding high-calorie nutrition, such as soy milk, broth, etc., rapid improvements in physical condition, to enhance surgical tolerance. This can avoid the post-operative blood transfusion, plasma and protein transmission, to reduce the postoperative time a large number of complications caused by parenteral nutrition, while also lowering the cost of treatment.

Hearts for high-Aging lower segment esophageal cancer surgery, we have taken the bed to mention the stomach through the esophagus from the aortic arch, the arch with esophageal mechanical anastomosis, post-operative mediastinal esophagus stomach living in bed and avoid post-operative common "stomach chest syndrome" , reducing the loss of lung function. This surgical particularly suitable for low-and ultra-elderly patients with heart and lung functions. Some high lesions, including cervical and high thoracic esophageal cancer, in ensuring the principle of radical, based on a left cervical incision abdominal esophagus pull off the middle of two patients, avoiding the thoracotomy operation, improved safety. Or adopted by all the posterior lateral right chest, mouth, through the esophageal hiatus of free stomach, right chest, esophagus and stomach super-cupula pleurae anastomosis, avoiding the trauma of conventional large left cervical, right chest and upper abdomen of posterolateral incision in the middle of three. The stomach through the esophageal bed substernal to mention the neck more than matched pairs of heart and lung function is much smaller. For the past have been OK gastrectomy the residual stomach esophagus, can be taken to the remnant stomach, spleen, pancreas tail pulled into the chest cavity, esophagus and stomach consistent way under the arch, if necessary, can be used esophageal replacement with colon. Some of the higher lesion is longer, may be outside the membranous tracheal invasion or large blood vessels, Kan Ying larger the perforation or ulceration of medullary-type esophageal cancer, preoperative radiotherapy may be given half the amount will increase the resection rate, increase esophageal cancer surgery security.

High-aging after esophagectomy radiotherapy and chemotherapy should be cautious not to over-exaggerate the need for and effect of postoperative chemotherapy. Should be based on patient's body and immune system recovery, and flexible use of a short course of chemotherapy. Pathological findings after surgery for esophageal cancer with lymph node metastasis, or palliative surgery patients can take appropriate radiotherapy.