P1.156. Outcomes of Curative Esophagectomy in Octogenarians vs Non-Octogenarians With Esophageal Cancer: A Systematic Review and Meta-Analysis

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Esophageal cancer (EC) poses a growing global challenge in the context of an aging 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, vs in non-octogenarians. Methods A systematic search was performed on PubMed, Embase, Web of Science and Cochrane Library till May 2025. The inclusion criteria were studies which compared outcomes of esophagectomy for EC between octogenarians vs non-octogenarians. Exclusion criteria were single-arm studies, different age cut-offs. Results There were 18 studies with 73776 patients (octogenarians n=6234, non-octogenarians patients n=67542). Overall incidence of open esophagectomy and minimally invasive esophagectomy (MIE) were 78.4% (n=459/585) and 21.2% (n=124/585) in octogenarians and 69.8% (n=3270/4688) and 29.4% (n=1380/4688) in non-octogenarians respectively. R0 resection was achieved in 85.2% (n=1759/2064) of octogenarians and 91.9% (n=30764/33480) of non-octogenarians. Pooled OS was inferior in the octogenarian group compared to the non-octogenarian group (n=35441, HR 2.29, 95% CI: 1.38-3.79). Pooled in-hospital mortality, 30-day mortality and 90-day mortality was worse in octogenarians. In terms of post-operative complications, pooled analysis demonstrated worse overall complication rate in the octogenarian group (n=6515, OR 1.40, 95% CI: 1.11-1.78), and comparable anastomosis leak, chylothorax, respiratory complication, surgical site infection and recurrent laryngeal nerve injury rates between the two groups. Conclusion 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 roles of MIE in octogenarians should be conducted.