Comparing Survival and Complication Rates in Cervical vs. Intrathoracic Anastomosis for Elderly Esophageal Cancer Patients

Background With the global trend of an aging population, the management of esophageal squamous cell carcinoma (ESCC) in elderly patients has become increasingly critical. Surgical resection continues to be the primary treatment option. This study aimed to compare the outcomes of cervical anastomosis (CA) and intrathoracic anastomosis (IA) in elderly patients diagnosed with ESCC. Methods This retrospective cohort study analyzed 469 ESCC patients aged over 70 who underwent esophagectomy between May 2016 and August 2021. Patients were divided into CA and IA groups. The primary outcomes were overall survival (OS) and disease-free survival (DFS), assessed using Kaplan–Meier analysis, log-rank test, and Cox regression. Propensity score matching (PSM) was performed to adjust for potential confounders. Postoperative complications were classified using the Clavien-Dindo system. Results The median follow-up was 47.5 months. Pre-PSM analysis showed the CA group had a significantly longer median OS (50.7 months vs. 31.7 months, HR: 1.421, P = 0.045) compared to the IA group. However, after PSM, this difference became statistically non-significant (HR: 1.366, P = 0.196). Similarly, DFS was not significantly different between groups post-PSM. The CA group had a higher incidence of Clavien-Dindo grade III and IV complications (P = 0.050), though this became non-significant after matching (P = 0.072). Conclusion While initial analysis suggested potential advantages for CA, PSM revealed no statistically significant differences in OS, DFS, or complication rates between CA and IA techniques in elderly ESCC patients.