Outcomes after oesophageal resection in octogenarians: a nationwide population-based cohort study
Hampus af Malmborg, Gustav LinderAbstract
Introduction
The incidence of oesophageal cancer increases with age, yet octogenarians remain underrepresented in surgical series. Evidence regarding the safety and oncological outcomes of oesophageal resection in patients aged 80 years or older is limited. This study aimed to evaluate short- and long-term outcomes in octogenarians undergoing oesophageal resection compared to younger patients.
Methods
All patients undergoing oesophageal resection for cancer in Sweden between 2006 and 2025 were identified from the national register for oesophageal- and gastric cancer (NREV). Patients were stratified by age (<80 versus ≥80 years). Thirty- and 90-day mortality were analysed using multivariable logistic regression. Overall survival was assessed using Cox proportional hazards regression, adjusting for sex, ASA classification, clinical stage, histology, tumour location, surgical technique, neoadjuvant treatment, surgical complications, and year of surgery.
Results
Of 3326 patients, 178 (5.4%) were octogenarians. Thirty-day mortality was significantly higher in octogenarians (OR 3.12, 95% c.i. 1.15–8.48), as was 90-day mortality (OR 2.70, 95% c.i. 1.36–5.37). Surgical complications were the strongest predictor of perioperative mortality (OR 4.54 at 90 days). Five-year overall survival was 31.4% in octogenarians versus 43.8% in younger patients. On multivariable Cox regression, age ≥80 remained an independent predictor of inferior survival (HR 1.38, 95% c.i. 1.09–1.74, P = 0.007).
Discussion
Octogenarians undergoing oesophageal resection face significantly higher perioperative mortality and inferior long-term survival compared to younger patients, independent of tumour stage and comorbidity. These findings underscore the importance of careful patient selection and optimised perioperative care in this growing patient population.