139 Outcomes and Comorbidity Profile of Elderly Patients Undergoing Oesophagectomy

Abstract Aim There is limited high-quality evidence assessing the efficacy and long-term outcomes of oesophagectomy among elderly patients despite the presence of the burden of comorbidities and reduced physiological reserve.This study aim to identify the comorbidity profile and postoperative trajectory that will guide to appropriate patient selection and perioperative planning, which can significantly influence surgical outcomes. Method A retrospective review of 138 patients, aged >75 years-old, who underwent Ivor Lewis Oesophagectomy in our institutions, between 2012 and 2025. Information gathered included patient comorbidities, ASA scores, neoadjuvant chemotherapy (NAC) and cancer staging. Outcomes including post-operative complications, length of stay, leak rate, survival and cause of death were analysed. Results Data analysis showed; median ASA score was 2. Prevalence of key comorbidities included ischaemic heart disease (14.6%), cerebrovascular accident (6.6%), diabetes mellitus (20.4%), chronic kidney disease (7.3%), and a smoking history in 16.2%. Neoadjuvant chemotherapy was administered to 23.9% of patients, and no patients over 80 years old. Median length of hospital stay was 11 days. Overall, five-year survival was 29.7% for adenocarcinoma, and 44.7% for squamous cell carcinoma, with 1/3 deaths unrelated to cancer. Clavien-Dindo 3+ complications were associated with a hazard ratio 2.2 of 5-year mortality (p=0.03), and 5.51 hazard ratio of non-cancer related mortality (p=0.02). Conclusions This single-centre dataset highlights a substantial comorbidity burden among elderly patients undergoing upper GI cancer surgery, with low utilisation of neoadjuvant chemotherapy in comparison to baseline. Further strategies are necessary to identify elderly patients who may tolerate chemotherapy without increasing surgical risk in this cohort.