Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients

Abstract

Background and Aim: Endoscopic submucosal dissection (ESD) is reported to be a safe and reliable procedure for the elderly, but these reports could have already had a bias at the time ESD was performed. However, the reports have not clearly stated the criteria of indications. In the present study, we retrospectively elucidated the usefulness and problems of ESD for early gastric cancer in elderly patients (Ն 65 years) in comparison with non-elderly patients. Methods: The subjects were selected from 412 consecutive patients with early gastric cancer (515 lesions) for which ESD was performed between June 2002 and February 2010. The following were used for analysis between groups: pre-and postoperative performance status (PS) of subjects, prevalence rates of pre-existing comorbidities, characteristics of lesions, treatment outcomes, durations of hospitalization, operating times, incidence rates of complications and durations of hospitalization, and postoperative hemorrhage rates, and duration of hospitalization in patients with anticoagulant therapy. Results: Of the lesions in the elderly, four patients (1.0%) were elderly with a PS of 3. The PS increased to six patients (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. The ratio of patients with a pre-existing comorbidity was higher in the elderly than in the non-elderly. There were no differences between the two groups in the characteristics of the lesions, their duration of hospitalization, their operating times, or the incidence rates of complications. However, the elderly with perforations had a significantly longer hospitalization than the comparable non-elderly. The percentage of the patients taking anticoagulant drugs was significantly higher among the elderly. Of the patients on anticoagulant therapy, the duration of hospitalization tended to be longer in the elderly but no significant difference was found. None of the non-elderly with postoperative hemorrhage had received anticoagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were in those who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group. Conclusion: We conclude that ESD is useful in elderly patients because there is a similar risk as for the non-elderly if the approach is individualized, and the following are taken into consideration when making the final decision of performing ESD in an elderly patient: patients should have a PS of 0, 1, or 2; determine whether or not anticoagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.

Perioperative Complications of Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Japanese Patients 75 Years of Age or Older

“…A recent report showed that significant risk factors for delayed bleeding include a reduced platelet count, extended prothrombin time, large extent of resection and positive/indeterminate lateral margin (32). Another report showed that a significantly higher proportion of elderly patients receive anticoagulant drugs compared to other patients and that these individuals are at an increased risk of postoperative bleeding (33). In July 2012, the Japan Gastroenterological Endoscopy Society (JGES) published guidelines for the use of endoscopic procedures in antithrombotic drug-users, stating that antithrombotic therapy should be continued prior to ESD (34).…”

Association between CT-Diagnosed Pneumonia and Endoscopic Submucosal Dissection of Gastric Neoplasms

“…Akasaka et al [8], Park et al [17] and Kato et al [19] described that old age was a risk factor for aspiration pneumonia after ESD, but Tokioka et al [21] and Watari et al [16] report that it is not a risk factor. In our study, old age was not a risk factor for aspiration pneumonia.…”

Surgical Procedures, Complications, and Prognosis for Gastric Cancer in the Very Elderly (^|^gt;85): A Retrospective Study

“…But ESD requires skill, has a high degree of difficulty, and is reported to have a longer operating duration. Treatment by ESD is thought to improve the patient's quality of life compared with laparotomy [14,16]. It is important to choose minimally invasive surgical procedures based on the preoperative determination of stage of cancer progression in order to improve the chances of recovery.…”