Esophagectomy in Octogenarians in the Minimally Invasive Era: A NSQIP Analysis of Surgical Outcomes

Background: Esophagectomy carries substantial morbidity and mortality with advanced age being a known risk factor. This study aims to evaluate the outcome of esophagectomy in octogenarians in the context of increasing adoption of minimally invasive esophagectomy (MIE). Methods: A retrospective cohort study was conducted using the National Surgical Quality Improvement Program database. Patients undergoing esophagectomy were stratified by age (<80 and ≥80). Univariate and multivariable analysis were used to assess the age and patient-dependent factors with surgical outcomes. Results: Among 11,210 patients identified who underwent esophagectomy, 447 were octogenarians. Overall, octogenarians experienced higher rates of 30-day mortality (p = 0.004), LOS (p = 0.0001), and serious complications (p = 0.001). Within the subset of MIE patients, morbidity (p = 0.001) and mortality (p = 0.051) remain elevated but significance was not reached for LOS (p = 0.116) between the two age groups. Multivariable analysis confirmed that age ≥80 was independently associated with serious complications (p = 0.008), readmission (p = 0.015), and extended LOS (p = 0.001). However, it was not an independent predictor of reoperation or anastomotic leak. MIE significantly decreased the rate of overall complications and extended LOS with a trend towards decreased mortality (p = 0.065). Conclusions: Octogenarians experience significantly higher morbidity, mortality, and post-surgical care needs. While age is a risk factor, patient-specific comorbidities and frailty are critical determinants of outcome. Furthermore, surgical approaches have a significant impact on the outcome of patients post-esophagectomy with MIE narrowing the outcome gap between the two age groups. These findings underscore the necessity for meticulous patient selection, preoperative optimization, and shared decision-making when considering esophagectomy in this growing demographic.