Endoscopic submucosal dissection for early gastric cancer in very elderly patients age 85 or older

Abstract

Background and study aims The safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in very elderly patients remains unclear. The aim of this study was to evaluate the safety and efficacy of ESD for EGC in patients age 85 years and older. Patients and methods Patients who underwent ESD for EGC between September 2003 and April 2015 were divided into 3 groups: the very elderly (≥ 85 years; 43 patients), the elderly (65 – 84 years; 511 patients), and the non-elderly ( ≤ 64 years; 161 patients). Adverse events (AEs) were used as the primary endpoint to assess the safety of ESD, and the ESD treatment outcomes (i. e., en bloc resection rate, complete en bloc resection rate, and curative resection rate) and the overall survival rate after ESD were the secondary endpoints. These parameters were retrospectively evaluated in the 3 groups. Results There were no significant differences in AEs (non-elderly, elderly, and very elderly: 7.3, 9.5, and 12.5 %, respectively, P = 0.491) or in the en bloc resection and complete en bloc resection rates among the three groups. However, there was a significant difference in the curative resection rates (non-elderly, elderly, and very elderly: 91.5, 84.1, and 77.1 %, respectively, P = 0.014). Regarding overall survival, there was a significant difference among the three groups (1-, 5-, and 10-year overall survival rates: non-elderly: 98.6, 90.2, and 74.7 %; elderly: 97.2, 86.2, and 61.9 %; and very elderly: 92.7, 66.8, and 34.4 %, respectively, P = 0.001). Moreover, the overall survival rate in the very elderly patients with cardiovascular disease was significantly lower than that in the very elderly patients without cardiovascular disease (P < 0.001). Conclusions ESD is an acceptable treatment for EGC in patients 85 years of age or older in terms of safety. However, the overall survival after ESD in the very elderly patients with cardiovascular disease was short.

Endoscopic submucosal dissection for suspected early gastric cancer: absolute versus expanded criteria in a large Western cohort (with video)

“…Most pEGCs were located in the gastric antrum (60/135, 44.4%) ( Table 2). The median size of pEGCs was 20 mm (interquartile range [IQR], [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], and this was larger in the expanded criteria (30 mm; IQR, 25-40) and outside criteria groups (30 mm; IQR, 20-50) versus the LGD LGD was commonly located in the antrum (24/42, 57.1%). The most common morphology of pEGC was Paris 0-IIa (54/135, 40.0%).…”

Twelve‐year natural history of early esophagogastric junction cancer in an extremely old patient

“…The mean life expectancy in Japan at the age of 85 years was reported to be 6 and 8 years for men and women, respectively . Although previous studies have reported that endoscopic resection of EGC can be carried out safely even in older patients, resection has not been shown to improve the prognosis of older patients . Therefore, as shown by the present patient, no treatment might be the appropriate strategy.…”

Endoscopic submucosal dissection for superficial esophageal neoplasms in elderly patients: A single‐center, large‐scale, retrospective study

“…Several studies have reported clinical outcomes of gastric ESD in elderly patients . A recent meta‐analysis also showed that gastric ESD in elderly patients appears to be a safe procedure, and the long‐term prognosis was acceptable with favorable outcomes .…”

“…The extensive use of endoscopy has increased gastrointestinal cancer diagnosis at an early stage . As the elderly population increases, the proportion of elderly patients who will require endoscopic submucosal dissection (ESD) is expected to increase further.…”

“…Several studies have reported the efficacy and clinical outcomes of gastric ESD among elderly patients . In contrast, there is little evidence regarding clinical outcomes of esophageal ESD among the elderly .…”