Clinical Outcomes of Minimally Invasive Esophageal Surgery for Older Esophageal Cancer Patients: A Propensity Score-matched Study

Background: Recently, the number of older esophageal cancer patients has increased. Thoracoscopic esophagectomy, a minimally invasive surgery, is expected to improve surgical and clinical outcomes. But its outcome in older adults remains unclear. We aim to investigate the feasibility and safety of thoracoscopic esophagectomy in older patients. Methods: We retrospectively enrolled 132 thoracic esophageal cancer patients who underwent thoracoscopic esophagectomy between January 2014 and January 2024. The patients were divided into 2 groups: non-older (<75 years) and older (>= 75 years). A propensity score-matching (PSM) analysis was conducted based on sex, clinical T stage, and clinical N stage, resulting in 30 matched pairs. Patient characteristics, surgical procedures, postoperative complications, changes in nutritional status, and overall survival (OS) were compared between the 2 groups. Results: Preoperative serum albumin levels were found to be lower in the older group compared to the non-older group (P <.05); nonetheless, the nutritional status of 6 months after esophagectomy was similar between the 2 groups. There were no significant intergroup differences in the incidences of recurrent nerve palsy, pneumonia, and anastomotic leakage (older vs non-older group: 13.3% vs 13.3%, P = 1.0; 16.6% vs 20.0%, P = 0.73; and 13.3% vs 13.3%, P = 1.0, respectively). The in-hospital mortality rate for the older group was 2.9%, showing no significant difference compared with the non-older group (P = 0.14). Overall, the OS was poor in the older group (P <.05); however, it was similar between the 2 groups after PSM (P = 0.36). Discussion: For older patients, minimally invasive esophageal surgery is a feasible and safe option, offering acceptable short- and long-term outcomes.