Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older

Abstract

Background Only a few studies have reported long-term outcomes for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) in elderly patients. The aim of this study was to evaluate the efficacy of ESD for EGC in elderly patients C75 years with respect to both short-and long-term outcomes. Methods We reviewed the clinical data of elderly patients C75 years who had undergone ESD for EGC at Tonan Hospital from January 2003 to May 2010. Results A total of 177 consecutive patients, including 145 with curative resection (CR) and 32 with noncurative resection (non-CR), were examined. Of the 32 patients with non-CR, 15 underwent additional surgery, and lymph node metastases were found in 3 patients. The remaining 17 patients were followed without additional surgery because of advanced age or poor general condition. Procedure-related complications, such as post-ESD bleeding, perforation and pneumonia, were within the acceptable range. The 5-year survival rates of patients with CR, those with additional surgery after non-CR, and those without additional surgery after non-CR were 84.6, 73.3, and 58.8 %, respectively. No deaths were attributable to the original gastric cancer; patients succumbed to other illnesses, including malignancy and respiratory disease. ConclusionsIn elderly patients, ESD is an acceptable treatment for EGC in terms of both short-and longterm outcomes. Careful clinical assessment of elderly patients is necessary before ESD. After ESD, medical follow-up is important so that other malignancies and diseases that affect the elderly are not overlooked.

Impact of the Charlson comorbidity index and prognostic nutritional index on prognosis in patients with early gastric cancer after endoscopic submucosal dissection

“…According to the Annual Health, Labour and Welfare Report 2015, life expectancy in Japan was 80.50 years for men and 86.83 for women . Unlike our study, several previous studies defined elderly patients as those aged ≥75 years for evaluating the outcomes of ESD for EGC . Considering that life expectancy in Japan was over 80 years of age, we defined elderly patients as those aged ≥80 years, as in other previous studies .…”

“…26 Unlike our study, several previous studies defined elderly patients as those aged ≥75 years for evaluating the outcomes of ESD for EGC. 6,7,[10][11][12] Considering that life expectancy in Japan was over 80 years of age, we defined elderly patients as those aged ≥80 years, as in other previous studies. 9,13 With regard to comorbidities, we evaluated CCI to predict the prognosis in patients with EGC after ESD.…”

“…Previous studies have shown that ESD is effective even in elderly patients with regard to short-and long-term outcomes. [5][6][7][8][9][10][11][12][13] In addition, some studies have recently investigated the long-term outcomes of ESD in elderly patients with EGC from the perspective of comorbidities, nutritional status, or Eastern Cooperative Oncology Group (ECOG) performance status (PS). 5,8,14 With the aging of society, comorbidities or nutritional status are assessed prior to ESD for EGC.…”

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

“…Among a total of 18 articles identified, the perforation rate was 3.02% (512/16 941) and 98.8% of patients (506/512) recovered without surgical intervention . Risk factors for intraoperative perforation during gastric ESD are listed in Table .…”

“…Among a total of 18 articles identified, the perforation rate was 3.02% (512/16 941) and 98.8% of patients (506/512) recovered without surgical intervention. 3,101,102,104,105,108,109,112,113,122,123,125,[131][132][133][134][135][136] Risk factors for intraoperative perforation during gastric ESD are listed in Table 7. For location, upper third, 98-105 middle third, 105,106 greater curvature and remnant stomach, 107 were reported to be high-risk areas for intraoperative perforation.…”