Postoperative outcomes in octa- and nonagenarian gastric and esophageal cancer patients: a retrospective single center analysis with propensity score matching

Introduction: With the global aging population, surgical management of gastric and esophageal malignancies in the elderly – and especially – octogenarians necessitates evidence-based risk assessment. While curative resection remains pivotal, concerns persist regarding age-related postoperative morbidity and mortality.

Goal: This study aimed to retrospectively compare the incidence and spectrum of postoperative complications following surgery for esophageal or gastric cancer in patients aged over 80 years versus those under 80 years, and to identify factors associated with increased morbidity in the elderly cohort.

Methods: We analyzed 737 consecutive patients treated at a tertiary center between 2014–2023. Cohorts were stratified by age (80 years; 28 patients over 80 years were included), data included demographics, comorbidities, surgical approach (open vs. MIC), and postoperative complications graded by Clavien-Dindo classification. Multivariate logistic regression identified risk factors for morbidity. Statistical analyses included chi-squared tests for categorical variables and multivariate logistic regression to identify independent risk factors for complications. Propensity score matching was performed to reduce the risk of bias.

Results: While preoperative medical comorbidities (e. g. congestive heart failure) were more frequent in the elderly group, other preoperative patient and tumor characteristics (e.g. UICC stages, BMI, ASA-Score) and surgical approach were not different between groups. While there was a trend toward more Clavien-Dindo 3 complications in the elderly group and textbook-outcomes were more frequent in the younger group, this was not statistically significant. Comprehensive Complication Index was also not statistically different between groups and neither length-of-stay (ICU or overall) or time until oral refeeding differed significantly.

Conclusion: In conclusion, despite a higher prevalence of preoperative medical comorbidities in elderly patients, postoperative outcomes-including rates of major complications, textbook outcomes, overall complication burden, length of stay, and time to oral refeeding-were not significantly different between patients older than 80 years and those younger than 80 years. These findings suggest that advanced age alone should not be considered a contraindication for surgical treatment of gastric and esophageal cancer, provided that careful patient selection and perioperative management are ensured.

Publication History

Article published online:
04 September 2025