Evaluating Body Mass Index in Survival and Complications of Older Oesophageal Squamous Cell Carcinoma After Esophagectomy: A Propensity Score Analysis

Background Oesophageal squamous cell carcinoma (OSCC) is a prevalent cancer in the elderly, with surgical resection as a primary treatment. This study investigates the impact of Body Mass Index (BMI) on postoperative outcomes in elderly OSCC patients who underwent esophagectomy. Methods We conducted a retrospective cohort study using data from the Sichuan Cancer Hospital & Institute, focusing on patients aged 70 and older diagnosed with thoracic OSCC who underwent esophagectomy between May 2016 and August 2021. Patients were categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), and overweight/obese (≥25 kg/m2) groups based on BMI. Primary outcomes were overall survival (OS) and disease-free survival (DFS), while secondary outcomes included postoperative complication rates, assessed using the Clavien-Dindo classification. Results The study included 469 patients, with a median follow-up of 47.5 months. The median OS for normal, high, and low BMI groups was 50.7, 36.9, and 33.5 months, respectively, with no significant differences in OS among the groups. DFS also showed no significant differences. Complication rates were higher in the low BMI group, including pulmonary infections, hydrothorax, and chylous fistula. Conclusion BMI did not significantly affect OS or DFS among elderly OSCC patients post-esophagectomy, though low BMI was associated with higher complication rates.