Outcomes of Older Patients Undergoing Surgery for Esophageal Squamous Cell Carcinoma

Esophageal cancer is a leading cause of death among males worldwide, including Japan, where squamous cell carcinoma is the most common type. Treatment decisions can be complicated, especially for older patients undergoing esophagectomy, which, while effective, is invasive and incurs significant risks.

A retrospective review of 126 consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent open or thoracoscopic esophagectomy between January 2010 and April 2023 was conducted. Older patients aged ≥75 years (n=24) were compared with non-older patients aged <75 years (n=102).

Both estimated Glomerular Filtration Rate (eGFR) and albumin levels were notably lower in older patients with a more extensive medical history and higher American Society of Anesthesiologists Physical Status scores. However, there were no differences in sex, Body Mass Index, or pathological stage. Both groups showed similar characteristics in terms of the esophagectomy approach, field dissection, preoperative treatment, operation duration, bleeding, postoperative complications, and hospital stay. No differences were observed between non-older and older groups regarding overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS) (5-year OS: 63.4% vs. 29.2%, respectively, p=0.119; 5-year RFS: 48.6% vs. 33.9%, respectively, p=0.612; 5-year DSS: 73.2% and 46.2%, respectively, p=0.978). Additionally, multivariate survival analysis indicated that pathological N stage [hazard ratio (HR)=2.13; 95% confidence interval (CI)=1.10-4.12; p=0.025] and pathological T stage (HR=2.16; 95%CI=1.13-4.15; p=0.021) were independent prognostic factors for OS. However, age was not a prognostic factor.

Esophagectomy for patients aged 75 years or older provides comparable long-term outcomes without increasing postoperative complications compared with patients younger than 75 years.