Age and comorbidity do not raise severe complication risk after minimally invasive esophagectomy

BACKGROUND: Perioperative risks in older, comorbid, and frail patients undergoing open esophagectomy are increased, whereas these risks remain uncertain for minimally invasive esophagectomy (MIE). This study investigates the relationship between age, comorbidity, frailty, and complications after MIE. METHODS: Prospective data from the randomized ICAN trial were used, which compared intrathoracic and cervical anastomosis in adult esophageal cancer patients undergoing MIE. Patients were categorized by age (<75 and ≥ 75 years), comorbidity (ASA, Charlson Comorbidity index (CCI), Cumulative Illness Rating Scale for Geriatrics (CIRS-G)), and frailty (TOPICS-MDS ≥0.20). Primary outcome: severe complications (Clavien-Dindo grade ≥ 3a). Secondary outcomes: overall complications, hospital and intensive care unit (ICU) length of stay (LOS), and hospital readmission. Multivariable regression analysis adjusted for gender and anastomosis location. RESULTS: Among 245 patients, 87 (35.5%) had severe complications. Eighteen (7.3%) were aged ≥75 years, 49 (20%) had ASA ≥3, 41 (16.7%) had CCI ≥2, median CIRS-G score was 3 (IQR 2.0), and 14 patients (5.7%) were frail. In multivariable regression, age, ASA ≥3, CCI ≥2, and CIRS-G were not independently associated with severe complications, overall complications, readmission, hospital or ICU LOS. Multivariable regression analysis for frailty was limited by the small number of frail patients. CONCLUSIONS: Older and comorbid patients did not experience higher rates of severe complications following MIE, suggesting that they may be considered safe candidates for MIE despite their age. When selected according to current clinical practice, age, and comorbidity alone should not rule out surgical consideration.