Long-term prognosis after endoscopic submucosal dissection for early gastric cancer in super-elderly patients

Abstract

ESD was performed safely, and death related to gastric cancer was prevented in super-elderly patients with comorbidities, regardless of the degree of the disease. However, patients with comorbidities are at a high risk of poor prognosis.

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

“…Regarding long‐term outcomes, the main cause of death was other‐organ malignancy in patients who underwent ESD for EGC. Yoshifuku et al . reported that the main cause of death in patients aged ≥85 years who underwent ESD for EGC was pneumonia.…”

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.…”

Management of non-curative endoscopic submucosal dissection for early gastric cancer: do we have enough data to support this?

“…Those aged more than 75 years accounted for 12.3% of the Japanese population as of 2013, and this is expected to reach 27% by 2060 (13). More importantly, the super-elderly population (aged more than 85 years) increased from 1.4 to 4.8 million during the last two decades (14). As our aging society advances, super elderly people with gastric cancer have increased annually.…”

“…As our aging society advances, super elderly people with gastric cancer have increased annually. Opportunities to perform ESD for EGC in super elderly patients have surely increased (14). Compared to surgical intervention, ESD is less invasive, and it improves their quality of life preserving gastric function.…”

“…On the other hand, a retrospective analysis with the small number of patients have revealed that there is a substantially higher frequency of death in EGC patients with comorbidities than those without comorbidities in elderly patients who received ESD; that is, that the causes of death were mostly related to their comorbidities in elderly patients. The biggest cause of death in super elderly patients was a procedure-related pneumonia (14). A recent meta-analysis has shown the elderly patients had a higher procedure-related pneumonia rate compared to non-elderly patients (17).…”