Feasibility and short-term outcomes of curative esophagectomy in octogenarian patients with esophageal cancer: a real-world retrospective study.

Background

The role of surgical treatment in patients aged ≥ 80 years with esophageal cancer remains controversial, and real-world evidence remains scarce. This study aimed to evaluate the perioperative safety and mid-term survival outcomes of octogenarian patients following radical esophagectomy.

Methods

This single-center retrospective cohort study consecutively enrolled patients aged ≥ 80 years who underwent radical esophagectomy at our institution between 2020 and 2025. Data on baseline characteristics, perioperative complications, 30-day and 90-day postoperative mortality, overall survival (OS), and disease-free survival (DFS) were collected. Multivariable logistic and Cox regression analyses were performed to identify independent prognostic factors.

Results

A total of 110 patients were included, with a mean age of 81.8 years; 67.3% were male, and 58.2% had COPD. The most common postoperative complications were pulmonary infection (49.1%) and arrhythmia (42.7%); 16 patients (14.5%) required transfer to the ICU because of severe complications. The perioperative mortality rate was 9.1% (10/110). The 90-day postoperative mortality rate was 13.6%. Multivariable logistic regression analysis demonstrated that higher BMI was a protective factor against 90-day mortality. After a median follow-up of 20 months, the 1-year and 2-year OS rates were 81% and 56%, respectively. Multivariable Cox regression analysis indicated that age was the only independent predictor of overall survival (HR, 1.22).

Conclusion

Curative esophagectomy may remain feasible in carefully selected octogenarian patients, although perioperative morbidity and mortality remain substantial; therefore, treatment decisions should be based on comprehensive multidisciplinary evaluation rather than age alone.