Improved operative mortality after esophagectomy in patients aged ≥ 75 years over a decade: a nationwide…

Cohort studyEsophagus : official journal of the Japan Esophageal Society· Sep 2026

Improved operative mortality after esophagectomy in patients aged ≥ 75 years over a decade: a nationwide Japanese retrospective cohort study.

Akihiko Sano, Hideki Endo, Hiroyuki Yamamoto … Hiroshi Saeki

Complex General Surgical OncologyCohort studyQ1IF 5.4

Operative mortality after esophagectomy fell over a decade in patients aged ≥75 years, independent of minimally invasive surgery adoption

Improved operative mortality after esophagectomy in patients aged ≥ 75 years over a decade: a nationwide Japanese retrospective cohort study.

Akihiko Sano … Hiroshi Saeki

Esophagus · Sep 2026

Background

Esophagectomy is associated with substantial morbidity and mortality, particularly in older patients.

Purpose

This study aimed to evaluate temporal trends in short-term outcomes after esophagectomy in patients aged ≥ 75 years and determine whether the increasing adoption of minimally invasive surgery contributed to improved operative mortality.

Methods

Using the Japanese National Clinical Database, we analyzed patients aged ≥ 75 years who underwent radical esophagectomy for esophageal cancer between 2014 and 2024.

n = 7,678 patients

Results

after risk adjustment, operative death odds roughly halved over the decade in patients 75 and older

OR by subgroup · 95% CI

More results

Among 7,678 patients, patient complexity increased over time, with higher proportions of octogenarians, patients with American Society of Anesthesiologists Physical Status ≥ 3, and patients receiving preoperative chemotherapy.

Open thoracotomy decreased from 53.1% to 6.5%, whereas robot-assisted esophagectomy increased from 0% to 34.8%.

More results

Risk of severe postoperative complications remained unchanged (adjusted OR = 1.12, 95% CI 0.98-1.29; P = 0.11).

Mortality reduction remained significant after adjustment for minimally invasive surgery (OR = 0.58, 95% CI 0.41-0.83; P = 0.003).

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Conclusion · 1 of 3

Despite increasing patient complexity, operative mortality after esophagectomy in older patients improved substantially over the past decade.

Conclusion · 2 of 3

This improvement was unlikely to be explained by the increasing use of minimally invasive surgery alone and may reflect broader advances in perioperative management and other system-level factors.

Conclusion · 3 of 3

These findings have important implications for surgical care in aging populations worldwide.

Improved operative mortality after esophagectomy in patients aged ≥ 75 years over a decade: a nationwide Japanese retrospective cohort study.

Improved operative mortality after esophagectomy in patients aged ≥ 75 years over a decade: a nationwide Japanese retrospective cohort study.

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