Clinical impact of evaluation of frailty in endoscopic submucosal dissection for early gastric cancer in elderly patients

Abstract

Aims: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is performed safely and effectively in elderly patients; however, whether ESD for EGC in elderly patients with frailty is safe and improves prognosis remains unclear.Methods: In total, 142 patients aged ≥80 years who underwent ESD for EGC between September 2008 and September 2014 were included. We compared outcomes between patients with frailty and those without frailty. Frailty was assessed using the Clinical Frailty Scale (CFS) based on a patient's status before admission. Study endpoints were short-and long-term clinical outcomes after ESD.Results: Patients were allocated into two groups: no frailty (CFS 1-3, n = 101) versus frailty (CFS 4-7, n = 41). Short-term clinical outcomes, specifically, adverse events and curability, did not differ between the two groups. For the long-term clinical outcomes, patients with frailty had significantly worse outcomes after ESD than those without frailty (the 3-year overall survival rates were 73.2% vs. 93.1%; P < 0.001 with log-rank test). The Cox proportional hazards model showed that frailty was only an independent risk factor for poor prognosis.Conclusions: ESD for EGC is safe for elderly patients with or without frailty. However, elderly patients with frailty have a significantly poorer prognosis than those without frailty after ESD. Our results indicate that the frailty evaluation may be helpful to determine whether ESD for EGC should be performed. Geriatr Gerontol Int 2020; 20: 461-466.

Predictors of early and late mortality after the treatment for early gastric cancers

“…14,15 According to previous reports, about 50% of mortality occurred within 3 years after the treatment for EGC. 16,17 Additionally, 3 years is one of the major indicators for the long-term prognosis in studies about gastric cancer; [18][19][20][21] thus, it might be significant to evaluate predictors for mortality before and after 3 years, separately. Therefore, the cut-off value was determined as 3 years after a series of treatment for EGC in the present study.…”

Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis

“…Two articles (12,23) were obtained from the same population and reported the different clinical outcomes. Finally, eight studies reported on nine articles (12,13,(15)(16)(17)(18)(23)(24)(25) were included in the meta-analysis (Figure 1).…”

“…An early systematic review only described the association between frailty and adverse outcomes in patients with gastric cancer undergoing gastrectomy (11). Subsequently, several new articles (12)(13)(14)(15)(16)(17) that investigated the predictive utility of frailty in patients with gastric cancer have pursued a meta-analysis that applies accumulating clinical evidence. Nevertheless, the value of the frailty in predicting overall survival remains conflicting in patients with gastric cancer (17,18).…”

Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

“…This is relevant irrespective of whether the patient undergoes advanced endoscopy under a general anesthetic or conscious sedation. While the Charlson co-morbidity index [33,34] and clinical frailty scale [35] have also been used to assess risk within endoscopy, these are supported by only a few smaller studies. Further work is required to determine the optimal modality to assess fitness for advanced endoscopic procedures.…”