PD08.02. Patterns in Surgical Outcomes and Survival in Elderly Patients Post Ivor-Lewis Oesophagectomy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Oesophagectomy remains a cornerstone of curative treatment for oesophageal cancer, yet management in elderly patients is significantly variable. This study evaluates peri-operative morbidity, mortality, and long-term survival in patients aged ≥75 years undergoing Ivor–Lewis oesophagectomy at a high-volume UK centre, with particular focus on the prognostic impact of postoperative complications. A retrospective analysis was performed of a prospectively maintained database including all patients undergoing Ivor–Lewis oesophagectomy between 2012 and 2024. Patients were stratified by age (<75 vs ≥75 years). Complications were classified using Clavien–Dindo and Esophagectomy Complications Consensus Group (ECCG) definitions. Overall survival was analysed using Kaplan–Meier methods and Cox regression modelling. A total of 634 patients were included, of whom 138 (21.8%) were aged over 75 years, including 46 patients aged ≥80. Older patients had higher ASA scores and experienced higher overall complication rates, particularly cardiorespiratory events, with increased unplanned ICU admission and higher 90-day mortality (7.2% vs 2.2%, p<0.01). Five-year overall survival was lower in patients over 75 (31.9% vs 48.1%), with non-cancer-related mortality accounting for a significantly greater proportion of deaths than patients </=75yo. On multivariable analysis, age >75, pathological stage, major complications (Clavien–Dindo III+), and ECCG grade III anastomotic leak were independently associated with worse survival. Major complications had a markedly greater adverse impact on long-term survival in older patients, with five-year survival falling to 7.7% following Clavien–Dindo III+ events. Carefully selected patients aged over 75 can achieve meaningful long-term survival following Ivor–Lewis oesophagectomy; however, major postoperative complications—particularly anastomotic leaks—are associated with profound and age-dependent reductions in survival. These findings underscore the importance of meticulous patient selection, optimisation, and multidisciplinary care to mitigate complications in elderly patients undergoing oesophagectomy.