Skip to main content
SpringerLink
Log in

Comparison of Long-Term Outcomes After Non-curative Endoscopic Resection in Older Patients with Early Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Limited data exist that describe the long-term outcomes from additional surgery following non-curative endoscopic resection (ER) of early gastric cancer (EGC) in older people. This study aimed to determine the appropriate treatment strategy for these patients.

Methods

We analyzed data from 2895 patients who underwent ER for EGC, of whom 451 (15.6%) had non-curative resections followed by curative surgery or surveillance only. Of these patients, 138 were older (aged ≥70 years). We compared the long-term outcomes of the different treatment strategies in the older patients with non-curative resections for EGC, and the outcomes of each treatment strategy, with those in younger patients.

Results

The older patients underwent curative resections, non-curative resections with surgery, or non-curative resections with surveillance, and the 5-year disease-specific survival (DSS) rates were 100, 100, and 73%, respectively. There was a trend toward significance for DSS in favor of the non-curative resections with surgery group compared with the non-curative resections with surveillance-only group (p = 0.069). Among those who did not undergo additional surgery, the older patients had worse DSS than the younger patients, and patients who underwent additional surgery had better DSS, irrespective of their ages. Multivariable analysis adjusted for other-cause mortality generated similar results. Overall survival and recurrence-free survival did not differ according to treatment strategy, and perioperative morbidity and mortality did not differ significantly according to age.

Conclusions

In older patients with non-curatively resected EGC, additional surgery demonstrated a trend toward better DSS, and perioperative complications did not increase significantly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Matsushita I, Hanai H, Kajimura M, et al. Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life. J Clin Gastroenterol. 2002;35:29–34.

    Article  PubMed  Google Scholar 

  2. McKenna RJ Sr. Clinical aspects of cancer in the elderly. Treatment decisions, treatment choices, and follow-up. Cancer. 1994;74:2107–17.

    Article  PubMed  Google Scholar 

  3. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Google Scholar 

  4. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–42.

    Article  PubMed  Google Scholar 

  5. Pyo JH, Lee H, Min BH, et al. Long-term outcome of endoscopic resection vs. surgery for early gastric cancer: a non-inferiority-matched cohort study. Am J Gastroenterol. 2016;111:240–9.

    Article  PubMed  Google Scholar 

  6. Chiu PW. Novel endoscopic therapeutics for early gastric cancer. Clin Gastroenterol Hepatol. 2014;12:120–5.

    Article  PubMed  Google Scholar 

  7. Lin JP, Zhang YP, Xue M, Chen SJ, Si JM. Endoscopic submucosal dissection for early gastric cancer in elderly patients: a meta-analysis. World J Surg Oncol. 2015;13:293.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Park CH, Lee H, Kim DW, et al. Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc. 2014;80:599–609.

    Article  PubMed  Google Scholar 

  9. Chiu PW, Teoh AY, To KF, et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc. 2012;26:3584–91.

    Article  PubMed  Google Scholar 

  10. Kim ER, Lee H, Min BH, et al. Effect of rescue surgery after non-curative endoscopic resection of early gastric cancer. Br J Surg. 2015;102:1394–401.

    Article  CAS  PubMed  Google Scholar 

  11. Ahn JY, Jung HY, Choi KD, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011;74:485–93.

    Article  PubMed  Google Scholar 

  12. Oda I, Gotoda T, Sasako M, et al. Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg. 2008;95:1495–500.

    Article  CAS  PubMed  Google Scholar 

  13. Duron JJ, Duron E, Dugue T, et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg. 2011;254:375–82.

    Article  PubMed  Google Scholar 

  14. Han JP, Hong SJ, Kim HK, et al. Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer. Surg Endosc. 2016;30:184–9.

    Article  PubMed  Google Scholar 

  15. Hoteya S, Iizuka T, Kikuchi D, et al. Clinicopathological outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection. Digestion. 2016;93:53–8.

    Article  CAS  PubMed  Google Scholar 

  16. Jung DH, Lee YC, Kim JH, et al. Additive treatment improves survival in elderly patients after non-curative endoscopic resection for early gastric cancer. Surg Endosc. 2017;31(3):1376–1382.

    Article  PubMed  Google Scholar 

  17. Kusano C, Iwasaki M, Kaltenbach T, Conlin A, Oda I, Gotoda T. Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? Long-term comparative outcomes. Am J Gastroenterol. 2011;106:1064–9.

    Article  PubMed  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  PubMed  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  20. World Health Organization Classification of Tumours. Lyon: IARC; 2010.

  21. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010.

  22. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

    Article  Google Scholar 

  23. Eom BW, Kim YI, Kim KH, et al. Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer. Gastrointest Endosc. 2017;85(1):155–163.

    Article  PubMed  Google Scholar 

Download references

Funding

No external sources of funding were received for this study.

Disclosure

Jeung Hui Pyo, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Kyoung-Mee Kim, Heejin Yoo, Soohyun Ahn, Ji Yeong An, Min Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Jae J. Kim, and Sung Kim declare that they have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Jeung Hui Pyo MD, Hyuk Lee MD, PhD, Byung-Hoon Min MD, PhD, Jun Haeng Lee MD, PhD & Jae J. Kim MD, PhD

  2. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Kyoung-Mee Kim MD, PhD

  3. Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea

    Heejin Yoo MS & Soohyun Ahn PhD

  4. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Ji Yeong An MD, PhD, Min Gew Choi MD, PhD, Jun Ho Lee MD, PhD, Tae Sung Sohn MD, PhD, Jae Moon Bae MD, PhD & Sung Kim MD, PhD

Authors
  1. Jeung Hui Pyo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyuk Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Byung-Hoon Min MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jun Haeng Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyoung-Mee Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heejin Yoo MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Soohyun Ahn PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ji Yeong An MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Min Gew Choi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jun Ho Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tae Sung Sohn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jae Moon Bae MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jae J. Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sung Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hyuk Lee MD, PhD.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 72 kb)

10434_2017_5888_MOESM2_ESM.tif

Supplementary material 2 (TIFF 413 kb) Supplementary Fig. 1 Absolute and Expanded indications of endoscopic resection for early gastric cancer (EMR, endoscopic mucosal resection; ESD, endoscopic submocosal dissection)

Supplementary material 3 (TIFF 430 kb) Supplementary Fig. 2 Study flow

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pyo, J.H., Lee, H., Min, BH. et al. Comparison of Long-Term Outcomes After Non-curative Endoscopic Resection in Older Patients with Early Gastric Cancer. Ann Surg Oncol 24, 2624–2631 (2017). https://doi.org/10.1245/s10434-017-5888-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-5888-1

Keywords

Search

Navigation