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.