Long-term outcomes of minimally invasive esophagectomy vs. open esophagectomy in older patients with esophageal squamous cell carcinoma: a propensity score matching analysis.

OBJECTIVE: Esophageal squamous cell carcinoma (ESCC) remains a significant health concern, particularly among older patients. While both minimally invasive esophagectomy (MIE) and open esophagectomy (OE) are established surgical types, there is ongoing debate about their comparative long-term outcomes in older patients. METHODS: This retrospective cohort study analyzed data from 469 patients with ESCC aged over 70 years who underwent esophagectomy between May 2016 and August 2021. Patients were divided into MIE and OE groups. Overall survival (OS), disease-free survival (DFS), and postoperative complications were evaluated. Propensity score matching was performed to minimize selection bias. Complications were assessed using the Clavien-Dindo classification system. RESULTS: Among 469 patients, 358 (76.33%) underwent MIE, while 111 (23.67%) underwent OE. After a median follow-up of 47.5 months, the MIE group had significantly better OS (median OS: 60.17 vs. 29.18 months, HR = 1.566, P = 0.002) and DFS (median DFS: 37.70 vs. 25.20 months, HR = 1.411, P = 0.010) compared to the OE group. After PSM, MIE remained associated with significantly improved OS (HR = 1.450, P = 0.039), while the difference in DFS was no longer significant (HR = 1.240, P = 0.201). The incidence of Clavien-Dindo grade III-IV complications was similar between groups. CONCLUSION: MIE is associated with better long-term survival outcomes compared to OE in older patients with ESCC, without increasing major postoperative complications. These findings support the consideration of MIE as a preferred surgical approach for older patients with ESCC to enhance survival and optimize postoperative recovery.