Outcomes of Curative Esophagectomy in Octogenarians vs. Non-Octogenarians with Esophageal Cancer: A Systematic Review and Meta-Analysis.

Abstract

Background: Esophageal cancer (EC) poses a growing global challenge in the context of an ageing population. Evidence on the role of curative esophagectomy in octogenarians is limited. This study aims to compare the long-term survival and post-operative mortality and morbidity in octogenarians undergoing curative esophagectomy for EC with those in non-octogenarians. Methods: A systematic search was performed on PubMed, Embase, Web of Science and Cochrane Library up to Jan 2026. The inclusion criteria were studies that compared outcomes of esophagectomy for EC between octogenarians and non-octogenarians. Exclusion criteria were single-arm studies and studies using different age cut-offs. Results: There were 18 studies with 73,776 patients (octogenarians n = 6234 and non-octogenarians patients n = 67,542), with smaller subsets of studies being analysed for individual outcomes. The overall incidence of open esophagectomy and minimally invasive esophagectomy (MIE) were 78.4% (n = 459/585) and 21.2% (n = 124/585), respectively, in octogenarians, and 69.8% (n = 3270/4688) and 29.4% (n = 1380/4688), respectively, in non-octogenarians. R0 resection was achieved in 85.2% (n = 1759/2064) of octogenarians and 91.9% (n = 30,764/33,480) of non-octogenarians. Pooled OS was inferior in the octogenarian group compared to the non-octogenarian group (n = 35,441, HR 2.29, 95% CI: 1.38-3.79). Pooled in-hospital mortality, 30-day mortality and 90-day mortality were higher in octogenarians. In terms of post-operative complications, pooled analysis demonstrated a higher overall complication rate in the octogenarian group (n = 6515, OR 1.40, 95% CI: 1.11-1.78), while rates of anastomosis leakage, chylothorax, respiratory complication, surgical site infection and recurrent laryngeal nerve injury were comparable between the two groups. Conclusions: Curative esophagectomy for EC is associated with worse overall survival, mortality and overall post-operative complication rate in octogenarians than non-octogenarians. Further research on the role of MIE in octogenarians should be conducted.