Perioperative outcomes following neoadjuvant immunochemotherapy in elderly patients with locally advanced esophageal squamous cell carcinoma

Objective This study compared the perioperative outcomes following neoadjuvant immunochemotherapy in elderly (≥70 years) and non-elderly patients with esophageal squamous cell carcinoma. Methods This retrospective study included patients with locally advanced esophageal squamous cell carcinoma who underwent neoadjuvant immunochemotherapy followed by esophagectomy (July 2020–June 2024). Patients were stratified into elderly (≥70 years) and non-elderly groups. Primary outcomes included 30-day mortality, 90-day mortality, 30-day readmission rate, and R0 resection rate. Secondary outcomes included pathological complete response, major pathological response, post-neoadjuvant pathological tumor/node stages, tumor regression grade, and complications. Results Among 73 patients (25 elderly, 48 non-elderly), no 30-day or 90-day mortality occurred in either group. The 30-day readmission rates (P = 0.331) and R0 resection rates (P > 0.999) were comparable between the two groups. Secondary outcomes, including pathological complete response (P = 0.685), major pathological response (P = 0.417), post-neoadjuvant pathological tumor stage (P = 0.732), post-neoadjuvant pathological node stage (P = 0.124), and tumor regression grade (P = 0.081), also showed no significant differences. The rates of complications, including severe (P = 0.825), pulmonary (P = 0.314), and cardiac (P = 0.269) complications; anastomotic leakage (P > 0.999); recurrent laryngeal nerve palsy (P > 0.999); and wound complications (P > 0.999), were similar between the two groups. Conclusion Elderly and non-elderly patients exhibited similar 30- and 90-day mortality, readmission, and R0 resection rates as well as comparable pathological responses and complication profiles following neoadjuvant immunochemotherapy. These findings indicate that age alone cannot exclude elderly patients from receiving neoadjuvant immunochemotherapy, and patients should undergo thorough individualized assessment and optimization.