Esophagectomy in Octogenarians in the Minimally Invasive Era: A NSQIP Analysis of Surgical Outcomes
- 1Department of Surgery, University of Calgary, North Tower 1014, 1441 29th Street NW, Calgary, AB T2N 4J8, Canada
Abstract
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.
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BibTeX
@article{xu2026esophagectomy,
title = {{Esophagectomy in Octogenarians in the Minimally Invasive Era: A NSQIP Analysis of Surgical Outcomes}},
author = {Joshua Xu and Mary Hou and Estifanos Debru and Neal Church and Philip Mitchell and Daniel Meyer},
journal = {Journal of Clinical Medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197590},
url = {https://www.mdpi.com/2077-0383/15/19/7590},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Esophagectomy in Octogenarians in the Minimally Invasive Era: A NSQIP Analysis of Surgical Outcomes
AU - Joshua Xu
AU - Mary Hou
AU - Estifanos Debru
AU - Neal Church
AU - Philip Mitchell
AU - Daniel Meyer
PY - 2026
DA - 2026/09/30
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15197590
UR - https://www.mdpi.com/2077-0383/15/19/7590
AB - 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.
SN - 2077-0383
ER -