Single-factor analysis showed that preoperative comorbidity, tumor pathological stage, lymph node metastasis status, lesion length, nature of surgery, and postoperative radiotherapy were the main factors affecting prognosis; while multi-factor analysis showed that surgical mode, tumor pathological stage, lymph node metastasis, and postoperative radiotherapy were the most important independent factors affecting prognosis. Conclusion Advanced esophageal cancer with early clinical stage and high radical surgical resection rate should strengthen the awareness of early diagnosis and treatment, and active surgical treatment should be performed if patients can tolerate surgery; surgical method, tumor pathological stage, lymph node metastasis, and postoperative radiotherapy are the most important factors affecting prognosis. High-aged esophageal cancer; surgery; prognosis Esophageal cancer is one of the six most common malignant tumors in the world, with extremely poor prognosis, and the 5-year survival rate of patients with intermediate and advanced stages is only about 10.0%. China is one of the countries with high incidence of esophageal cancer in the world, with an average of about 150,000 deaths per year, ranking 2nd after stomach cancer. Esophageal cancer is a common tumor disease with an older age of onset, more men than women, with an incidence rate of about 31.66/100,000 for men and 15.93/100,000 for women, and the age of onset is mostly above 40 years old. With the aging of society, the treatment of advanced esophageal cancer has become a serious real problem in oncology. In order to explore the surgical treatment of senior esophageal cancer and its factors affecting the prognosis, the clinical data of 76 cases of senior esophageal cancer over 70 years old treated by surgery in our hospital are analyzed and reported as follows. 1. Data and methods 1.1 General data From January 2003 to April 2007, there were 76 cases of senior esophageal cancer patients who underwent surgical treatment in our hospital, including 50 men and 26 women, with a male to female ratio of 1. 92:1, aged 70 to 84 years old, and aged (73.7±2.8). The time from the appearance of symptoms to the consultation was 0.5 to 12 months, with an average of (4.4±2.6) months. The tumor length was (4.83±1.51) cm, including 29 cases above 5 cm; 4 cases in the cervical segment, 10 cases in the upper thoracic segment, 48 cases in the middle thoracic segment, and 14 cases in the lower thoracic segment. Postoperative pathological examination showed 73 cases of squamous carcinoma, 2 cases of adenocarcinoma and 1 case of carcinoid tumor; 19 cases of highly differentiated, 41 cases of moderately differentiated and 16 cases of low differentiated; 33 cases of lymph node metastasis. 1.2 Treatment method Before surgery, chest X-ray, chest CT, upper gastrointestinal barium meal, lung function and other examinations were performed to comprehensively understand the relationship between tumor and peripheral organs and blood vessels and the function of important organs in the whole body. All patients in the group quit smoking 7 d before surgery, performed respiratory preparation 3 d before surgery and intravenous nutrition for 1 to 2 d. All patients in the group were treated surgically, with 67 cases of radical resection; 9 cases of palliative resection, including 5 cases invading the trachea and 4 cases invading the thoracic aorta. There were 31 cases of open thoracotomy via the left side, including 25 cases of supra-arch anastomosis, 3 cases of infra-arch anastomosis and 3 cases of cervical anastomosis; 45 cases of triple-incision resection via the right thorax, abdomen plus neck, all of which had cervical anastomosis. 24 cases had postoperative radiotherapy and 52 cases had no postoperative adjuvant therapy. 1.3 Follow-up Patients were examined by chest X-ray, abdominal ultrasound, barium meal, chest CT, etc. to understand whether there was recurrence and metastasis of tumor. 1.4 Statistical methods Applying SPSS13.0 statistical software, the Kaplan-Meier method was used to calculate the survival rate and cumulative survival rate of 1 year and 3 years in the senior group, and the Log-rank test was applied to perform one-way analysis of survival rate and statistical comparison, and the Cox regression model was applied to further multifactorial analysis of survival rate. 2. Results 2.1 Survival 76 patients with esophageal cancer were followed up from November 2007 (outpatient consultation and telephone and follow-up letter survey) to November 2009, 74 cases were followed up, and the follow-up rate was 97.1%. 26 cases showed recurrence from 6 months to 3 years after surgery, including 3 cases of anastomotic recurrence and 11 cases of mediastinal recurrence. 24 cases showed liver, lung and supraclavicular lymph node metastasis from 5 months to 3 years after follow-up. Lymph node metastasis. The number of patients with 1 and 3 years of follow-up in the whole group was 34 and 16, respectively, and the survival rates at 1 and 3 years were 45.6% and 21.3%, respectively. 2.2 Surgical complications and morbidity and mortality rate Postoperative complications occurred in 22 cases (28.9%), including 2 cases of anastomotic fistula, 11 cases of pulmonary infection, 3 cases of pulmonary atelectasis, 2 cases of pleural effusion, 2 cases of cardiac arrhythmia, 1 case of anastomotic stenosis, and 1 case of celiac disease. There was no case of death within 30 d after surgery. 2.3 Univariate analysis Univariate analysis affecting prognosis, in which preoperative comorbidity, pathological stage of tumor, lymph node metastasis status, lesion length, nature of surgery and stage were factors affecting prognosis (P<0. 05), see Table 1. 3. Discussion With the increase of average life expectancy of our population, the number of senior esophageal cancer patients is increasing. At present, most scholars believe that surgery should be preferred as long as the patient can tolerate it and the surgery can remove the tumor completely, and age should not be the limitation of surgery. Its treatment effect is related to many factors such as patient's medical history, functional status of vital organs, perioperative management, pathological stage of tumor and postoperative comprehensive treatment. With the progress of esophageal surgery theory and technique, anesthesia technique, perioperative treatment, as well as the development and improvement of related science and equipment, the surgical treatment effect of esophageal cancer has been greatly improved, and the safety factor of surgery has been greatly enhanced. Therefore, in recent years, more and more esophageal cancer patients over 70 years old have chosen surgical treatment. Previously, the 3-year and 5-year survival rates of senior esophageal cancer surgical treatment were 17.2% and 9.6%, respectively, but the 1-year and 3-year survival rates of our esophageal cancer patients were 44.7% and 21.1%, respectively, higher than previous reports. The main reason for this is the improvement of patients' health and awareness of disease prevention, and the detection time of esophageal cancer is significantly earlier. Secondly, the improvement of surgical technique greatly reduced the occurrence of postoperative complications and improved the 3-year survival rate, and the necessary perioperative management and postoperative comprehensive treatment also played a very important role in improving the survival rate. Meanwhile, it is related to our adequate preoperative evaluation and strict control of surgical indications. SETO et al. reported that the 5-year survival rate of female patients with esophageal cancer was 10.1%, which was significantly better than 9.2% in men, and the reason for considering gender as a prognostic factor in elderly patients with esophageal cancer is unknown. The analysis of this study showed that age and gender did not have a significant effect on survival. Despite the lower tumor malignancy, patients of advanced age failed to have a longer survival than non-advanced age patients. The authors suggest that this may be related to the higher number of underlying diseases and more postoperative complications in the elderly patients themselves. In a univariate and multifactorial analysis of the survival rates of 1014 patients with esophageal cancer who had undergone surgery, Zhang He-lin et al. also found no statistically significant differences in the 1-year, 3-year, and 5-year survival rates among patients with upper, middle, and lower segments, and they concluded that lesion site was not an independent prognostic factor affecting survival rates, which is consistent with the findings of this paper. Ma Lichin et al. analyzed the characteristics of 99 patients with esophageal cancer over 70 years of age showing that lesion length was an independent influence on prognosis. ALTORKI et al. found that the 2-year survival rate of those with tumor length <5 cm was 19.2%, while the 2-year survival rate of those with tumor length >9 cm was only 1.9%. Based on the statistical results of the data in this paper, the author concluded that the length of lesions in different groups had a significant effect on the survival rate, because the longer the lesion length, the greater the possibility of malignancy, local invasion and distant metastasis of the tumor, and the worse the prognosis. The results of univariate analysis in this study showed that preoperative comorbidities among patients with esophageal cancer surgery directly affected the prognosis, because patients with preoperative comorbidities of cardiovascular, respiratory, metabolic and other diseases and malnutrition had caused different degrees of injury to the corresponding target organs, and the reserve function of each target organ had decreased, which easily caused complications after surgery, resulting in functional failure of different organs and affecting the long-term recovery and survival rate of patients. The surgical method has a great influence on the survival rate of patients after esophagectomy. Based on the biological characteristics of esophageal cancer, from the oncological point of view, resection of most of the esophagus plus lymph node dissection in three fields of the chest, abdomen and neck is the ideal surgical approach for local control of the tumor to achieve the goal of cure. This requires skilled surgeons to enhance the treatment of regional lymph nodes in the shortest possible time. Both complete resection of the lesion and lymph node dissection are required to ensure the safety of the operation. In this paper, univariate and multifactorial analyses showed that the surgical approach was an important factor affecting patient prognosis. The relationship between the degree of differentiation of tumor cells and prognosis is currently controversial, which may be due to the poor standardization of tumor grading systems and the better prognostic reference role of tumor staging. Based on the results of this study, the author concluded that the degree of tumor differentiation had no significant effect on survival. MATSUMOTO et al. reported that 20%-40% of patients with negative lymph node metastases on routine pathological examination still had recurrence after surgery, suggesting that micrometastases may have occurred at the time of primary tumor treatment, which further confirms the principle of “three early stages”: early detection, early diagnosis, and early treatment: Early detection, early diagnosis and early surgery are the keys to improve the survival rate. Some authors have pointed out that microscopic residual cancer cells in the lymphatic vessels or body circulation after surgical resection of the primary cancer and the resultant metastases are the source of failure. Postoperative chemotherapy for esophageal cancer has been shown to significantly improve the postoperative survival of patients, and the present study also confirmed that postoperative chemotherapy for elderly patients with esophageal cancer also improves survival, and that postoperative radiotherapy is an independent factor affecting patient prognosis in a multifactorial analysis. The synergistic effect of radiotherapy and chemotherapy has been noted by many scholars in China and abroad. The combination of chemoradiotherapy improves the control of local esophageal lesions and reduces recurrence and metastasis, thus improving the local control rate and survival rate.ROTMAN et al. concluded that the combination of chemotherapy and radiotherapy for tumor treatment can prevent the expression of drug-resistant genes in tumor cells, in addition to the mutual sensitization of both. Therefore, we should take a positive attitude towards the treatment of senior esophageal cancer, use various examination methods to improve the early diagnosis rate of senior esophageal cancer, improve the tolerance of surgery for senior patients by fully evaluating patients before surgery, strengthening perioperative management, actively dealing with preoperative comorbidities, improving cardiopulmonary function, and selecting appropriate surgical methods to improve the resection rate of tumor and lymph node clearance rate, and strengthening comprehensive treatment, so as to improve the efficacy of surgical treatment, reduce postoperative complications and prolong postoperative survival.