For patients aged 70 and older undergoing esophagectomy, surgical outcomes are influenced more by intraoperative factors than by age alone.

• Textbook outcomes were achieved in 45.4% of patients, improving from 39.6% to 51.2% over time (p = 0.001).
• Age ≥ 70 years is associated with worse overall survival (adjusted hazard ratio 1.39, p = 0.028), primarily due to increased non-relapse mortality (hazard ratio 2.11, p = 0.008), rather than higher recurrence rates.

Surgeons should prioritize optimizing perioperative care, as age alone should not deter intervention in this population.