Simple Summary
Choosing appropriate surgical treatment for patients aged 80 years or older with esophageal or esophagogastric junction cancer is important in aging populations. We retrospectively compared surgical outcomes between older and younger patients after matching them to reduce differences in patient, cancer, and treatment characteristics. Each group included 40 patients. Older patients had fewer lymph nodes removed and fewer severe postoperative complications. The rates of pneumonia, vocal cord paralysis, and leakage at the surgical connection did not differ significantly. Overall survival was poorer in older patients, whereas survival considering only deaths from esophageal or esophagogastric junction cancers did not differ significantly. These findings suggest that surgery may be feasible in carefully selected patients aged 80 years or older, but they do not establish superiority over non-surgical treatment. Surgical eligibility should therefore consider the patient’s overall condition, tumor characteristics, and anticipated surgical invasiveness rather than age alone.
Abstract
Background/Objectives With population aging, determining appropriate surgical indications for patients aged ≥80 years with esophageal or esophagogastric junction cancer has become increasingly important. This study compared perioperative and long-term outcomes between surgically treated patients aged ≥80 years and those aged <80 years. Methods: Patients who underwent surgery for esophageal or esophagogastric junction cancer between April 2009 and April 2026 were retrospectively analyzed. Propensity score matching was performed using sex, American Society of Anesthesiologists physical status, tumor location, histological type, clinical stage, surgical procedure, and neoadjuvant chemotherapy. After matching, 40 patients were included in each group. Perioperative outcomes, postoperative complications, overall survival (OS), and disease-specific survival (DSS) were compared. Results: Operative time, blood loss, and postoperative hospital stay did not differ significantly between the groups. Patients aged ≥80 years had fewer dissected lymph nodes (26.0 vs. 48.5, p = 0.003) and a lower incidence of Clavien–Dindo grade ≥IIIa complications (17.5% vs. 40.0%, p = 0.047). The incidences of pneumonia, recurrent laryngeal nerve palsy, and anastomotic leakage did not differ significantly. The 5-year OS was lower in patients aged ≥80 years (32.9% vs. 55.3%, p = 0.006; HR, 2.31; 95% CI, 1.24–4.28), whereas 5-year DSS did not differ significantly (55.4% vs. 69.0%, p = 0.122; HR, 1.86; 95% CI, 0.84–4.12). Conclusions: Surgery may be feasible in carefully selected patients aged ≥80 years. These findings do not establish a survival advantage over non-surgical treatment. Surgical eligibility should be based on overall condition, oncological factors, and anticipated surgical invasiveness rather than chronological age alone.