Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

Zhao, Jiting; Sun, Zhen; Jun-wei, Liang; Guo, Song; Huang, Di

doi:10.3389/fonc.2021.718684

Cited by 6 publications

(6 citation statements)

References 48 publications

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“…Therefore, our study suggests that ESD is considerably safe in patients aged ≥85 years. The perforation rate was significantly higher in the ≥85 years group, as pointed out in a previous meta-analysis [ 44 ]. However, the total AE rate in the ≥85 years group was not significantly different from those in the other groups in this study.…”

Section: Discussionsupporting

confidence: 65%

“…Although the rate of antithrombotic drug use was significantly higher in the ≥85 years group, no significant difference was observed in the rate of postoperative bleeding. None of the patients aged ≥85 years in this study had aspiration pneumonia, although a previous study reported an increased incidence of aspiration pneumonia in elderly patients [ 6 , 8 , 13 , 44 ].…”

Section: Discussionmentioning

confidence: 65%

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The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

Yoshikawa

Yamauchi

Hamasaki

et al. 2022

Cancers

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Endoscopic submucosal dissection (ESD) is a safe and minimally invasive method for the treatment of early gastric cancer (EGC). However, whether ESD for EGC is also safe and feasible in patients aged ≥ 85 years is unclear. The patients enrolled in this study were divided into three groups: age ≥ 85 years (44 patients, 49 lesions), age 65–84 years (624 patients, 687 lesions), and age ≤ 64 years (162 patients, 174 lesions). We evaluated the incidence of adverse events (AEs) and overall survival (OS) and disease-specific survival (DSS). We analyzed the factors that had a significant impact on the prognosis of patients aged ≥ 85 years. No significant differences were found in the incidence of AEs among the three groups (p = 0.612). The OS was significantly lower in patients aged ≥ 85 years (p < 0.001). Conversely, DSS was not significantly worse in patients aged ≥ 85 years (p = 0.100). The poor Geriatric Nutritional Risk Index correlated with poor prognosis in patients aged ≥ 85 years (p < 0.001). ESD is a safe and valid treatment for EGC in patients aged ≥ 85 years. However, the indications should be carefully decided because it is difficult to estimate the survival contribution of ESD for EGC in patients aged ≥ 85 years, especially in those with poor nutritional status.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 65%

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

Yoshikawa

Yamauchi

Hamasaki

et al. 2022

Cancers

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“…Regarding age, a recent meta-analysis revealed that elderly patients tended to be at increased risk of perforation, including both intraoperative and postoperative types, with a significantly increased risk among ≥80-year-old patients. 16 In general, the thickness of the gastric wall decreases due to mucosal atrophy with aging. 17 Elderly patients with a thin gastric wall may thus be at greater risk of perforation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for intraoperative and delayed perforation related with gastric endoscopic submucosal dissection

Mimura,

Yamamoto,

Suzuki

et al. 2024

J of Gastro and Hepatol

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Background and AimPerforation is one of the most important complications of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Several studies have examined risk factors for intraoperative and delayed perforations, but most were retrospective analyses with small numbers of patients.MethodsThis study represents a secondary analysis of a Japanese multicenter prospective cohort study. We investigated the factors associated with each type of perforation using 9015 patients with 9975 EGCs undergoing ESD between July 2010 and June 2012.ResultsIntraoperative perforation occurred in 198 patients (2.2%) with 203 lesions (2.0%), necessitating emergency surgery for four lesions (0.04% [2.0%, 4/203]). Delayed perforation occurred in another 37 patients (0.4%) with 42 lesions (0.4%), requiring emergency surgery for 12 lesions (0.12% [28.6%, 12/42]). Factors showing significant independent correlations with intraoperative perforation were upper or middle third of the stomach; remnant stomach or gastric tube; procedure time ≥100 min; tumor size >35 mm; body mass index (BMI) < 18.5 kg/m2; and ≥72 years. Factors showing significant independent correlations with delayed perforation were procedure time ≥60 min; BMI < 18.5 kg/m2; ≥75 years; ulceration; and tumor size >20 mm. Intraoperative perforation occurred most frequently at the greater curvature in the upper third of the stomach (7.9%), whereas delayed perforation occurred most frequently at the greater curvature in the middle third (1.2%).ConclusionThis multicenter prospective cohort study clarified the risk and risk factors of intraoperative and delayed perforation related to ESD for EGCs, providing information to help endoscopists reduce perforation.

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“…A meta-analysis identified the following as risk factors for perforation: liver disease, location in the upper stomach, a resection size > 20 mm, submucosal invasion, operation time > 2 h, depressed or flat lesions, and piecemeal resection [ 59 ]. Another meta-analysis, this time comparing gastric ESD in elderly and non-elderly patients, found a trend for significantly increased perforation risk among patients aged >80 years [ 60 ].…”

Section: Endoscopic Resectionmentioning

confidence: 99%

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

Vasconcelos¹,

Dinis-Ribeiro

Libânio

2023

Cancers

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Early gastric cancer comprises gastric malignancies that are confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic resection is currently pivotal for the management of such early lesions, and it is the recommended treatment for tumors presenting a very low risk of lymph node metastasis. In general, these lesions consist of two groups of differentiated mucosal adenocarcinomas: non-ulcerated lesions (regardless of their size) and small ulcerated lesions. Endoscopic submucosal dissection is the technique of choice in most cases. This procedure has high rates of complete histological resection while maintaining gastric anatomy and its functions, resulting in fewer adverse events than surgery and having a lesser impact on patient-reported quality of life. Nonetheless, approximately 20% of resected lesions do not fulfill curative criteria and demand further treatment, highlighting the importance of patient selection. Additionally, the preservation of the stomach results in a moderate risk of metachronous lesions, which underlines the need for surveillance. We review the current evidence regarding the endoscopic treatment of early gastric cancer, including the short-and long-term results and management after resection.

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Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 48 publications

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

Risk factors for intraoperative and delayed perforation related with gastric endoscopic submucosal dissection

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

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