Author/Authors :
Okimoto, Kenichiro Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Arai, Makoto Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Ishigami, Hideaki Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Taida, Takashi Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Saito, Keiko Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Maruoka, Daisuke Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Matsumura, Tomoaki Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Nakagawa, Tomoo Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Katsuno, Tatsuro Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan , Kato, Naoya Department of Gastroenterology - Graduate School of Medicine - Chiba University, Japan
Abstract :
Introduction
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is well accepted. However, its adaptation for elderly patients is unclear. This study aimed to investigate the prognosis and long-term outcomes of ESD for EGC in elderly patients aged ≥80 years by comparing their findings to the findings of patients aged <80 years.
Materials and Methods
The study included 533 patients (632 lesions). The patients were divided into an elderly group (age, ≥80 years; 108 patients; 128 lesions; mean age, 83.4 ± 2.7 years) and a nonelderly group (age, <80 years; 425 patients; 504 lesions; mean age, 69.6 ± 7.9 years). We compared patient and lesion characteristics, overall survival (OS), and disease-specific survival (DSS) between the 2 groups retrospectively. Multivariate analysis was performed to clarify the risk factors of death after ESD.
Results
The rate of curative resection and adverse events was not significantly different between the groups. The mean survival time periods with regard to OS/DSS in the elderly and nonelderly groups were 75.8 ± 5.9 and 122.8 ± 2.6 months (P < 0.05)/120.0 ± 3.0 and 136.4 ± 0.6 months (not significant), respectively. In the elderly group, eGFR <30 ml/min/1.73 m2 was an independent risk factor of death (hazard ratio = 5.32; 95% confidence interval = 1.39–20.5; P=0.015).
Conclusion
ESD for EGC can be performed safely and can achieve high curability with good prognosis in elderly patients aged ≥80 years. After ESD, close attention should be paid to elderly patients with severe chronic kidney disease.
