P1.234. Analysis of Prognostic Factors in Elderly Patients Following Minimally Invasive Esophagectomy for Esophageal Cancer

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes With the aging of the global population, an increasing number of elderly patients undergo esophagectomy for esophageal cancer. Elderly populations exhibit considerable heterogeneity in overall health status due to differences in comorbidities. However, the factors influencing long-term outcomes after minimally invasive esophagectomy in this population have not been fully elucidated. This study aimed to identify prognostic factors associated with long-term survival in patients aged ≥75 years who underwent minimally invasive esophagectomy. This retrospective study evaluated 110 patients aged ≥75 years who underwent minimally invasive esophagectomy (thoracoscopic or robot-assisted thoracoscopic esophagectomy) with lymph node dissection at Tohoku University Hospital in Sendai, Japan, between 2008 and 2021. Patients with pathological diagnoses other than squamous cell carcinoma or adenocarcinoma were excluded. Prognostic factors associated with overall survival, including patient, tumor, and surgical factors, were analyzed. Furthermore, the impact of these factors on esophageal cancer-specific mortality and non-cancer-related mortality was subsequently evaluated. Postoperative pneumonia (p<0.01) and pathological non-R0 resection (p<0.001) were identified as independent predictors of worse overall survival after minimally invasive esophagectomy. Esophageal cancer-specific mortality did not differ significantly between patients with and without postoperative pneumonia (p=0.160). Relapse-free survival also did not differ significantly between the two groups (p=0.202). In contrast, non-esophageal cancer-related mortality was significantly higher in patients who developed postoperative pneumonia (p=0.018). Among non-esophageal cancer-related deaths, respiratory diseases were the predominant cause of death in the postoperative pneumonia group, accounting for 9 of 11 deaths (81.8%). Reducing the incidence of postoperative pneumonia may be important for improving long-term outcomes after esophagectomy in elderly patients, particularly by decreasing non-cancer-related mortality. Careful preoperative risk assessment, strategies to minimize surgical morbidity, and structured postoperative rehabilitation with functional follow-up may contribute to improved long-term survival.