igf ir In the current study preoperative pulmonary functions

In the current study, preoperative pulmonary functions in the elderly patients were significantly poorer than those in the younger patients. The poor physiological conditions adversely affected the postoperative outcomes: rates of mortality and morbidity were higher in the elderly patients than in the younger patients (Table 3). Elderly patients typically have limited functional reserve and a poor performance status. Esophagectomy and anesthesia affect elderly patients, prolonging the period for recovery and hospital stay. Old age delays recovery from functional loss of physiological stress loads. However, in the current study, the compared data did not differ significantly, probably because of advanced perioperative care techniques and surgical technologies. Functional changes caused by aging adversely affect recovery following esophagectomy in elderly patients, particularly by prolonging the postoperative ICU and hospital stay. In the current study, longer survival was observed in the elderly patients than in younger patients, with no statistical significance. The association between esophagectomy and the survival outcome in elderly patients has been controversial. Differences in inclusion criteria, the lack of a standard definition of an elderly age, and variation in study designs may have caused variable discrepancies. From the viewpoint of treatment, the advantages of esophagectomy with lymph node dissection depend upon accurate tumor grading, which provides data valuable in determining whether adjuvant therapy is necessary. Moreover, surgery can resolve functional obstruction by a tumor, potentially preventing tumor-related complications and improving quality of life and nutritional support. Thus, the role of esophagectomy cannot be evaluated according to the result of survival outcomes. In the current study, patients with preoperative neoadjuvant therapy were excluded to avoid confounding factors attributable to unclear staging, which may crucially affect the outcome of surgery. Thus, the results of the current study are likely to accurately reflect the effects of age on the outcomes of esophagectomy. Cancer is an immunogenic disease, and the igf ir protects the body against tumorigenesis. The elderly population, with decreased immune function, has an increased risk of cancer, but age may change tumor behavior. In the current study, elderly patients who received less intensive chemotherapy and radiotherapy following esophagectomy showed a longer survival time (MST = 15.8 months) compared with the younger patients (MST = 13.7 months). Such a survival benefit in elderly patients seems to contradict the effects of a poor immune system in old age. This result supports the suggestion of Weksler et al that aging slows tumor growth, reduces metastasis, and increases survival. Age has diverse effects on both tumor growth and tissue aging. Cellular senescence seems to activate a potent mechanism of tumor suppression and protection, resulting in slow growth of cancer in elderly patients. However, various factors, including exposure to carcinogens and changes in the host defense during aging, may affect the outcomes of treatment for esophageal cancer. The current study could not determine the complex association between cancer and aging, but the effect of age on the treatment of elderly patients with esophageal cancer should not be neglected. Additional studies are necessary to understand the relationship between carcinogenesis and aging in detail. Considering the efficacy and benefits of esophagectomy in the elderly patients, the procedure must be used in combination with alternative nonsurgical treatments, such as chemotherapy and radiotherapy. Several studies have shown that in an advanced stage of cancer or a tumor relapse, when adjuvant or salvage therapy is used as a treatment option, elderly patients show a greater response to less intensive chemotherapy and/or radiotherapy than younger patients do. Reluctance to treat elderly patients and fear of toxicity are likely causes of the small number of elderly patients who receive chemotherapy and/or radiotherapy. Moreover, several randomized trials have shown no benefits of chemoradiotherapy. Furthermore, previous studies based on target therapy for esophageal cancer could not prove that it benefits treatment-related survival. Thus, considering these unsatisfactory results, esophagectomy alone yields more benefits in elderly patients than in younger patients.