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Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma

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Abstract

Background

Endoscopic submucosal dissection (ESD) has been widely applied in superficial esophageal squamous cell carcinoma (SESCC) as a minimally invasive treatment, which has advantages over surgery, especially in the elderly who have high risk of surgery. This study elucidated the efficacy and safety of ESD for SESCC in the elderly.

Methods

Between April 2007 and June 2016, a total of 176 patients with SESCC treated with ESD were analyzed. Clinical outcomes including En bloc, complete, and curative resection rates, procedure-related complication rates, and cumulative recurrence rates were compared between the elderly (n = 46, ≥70 years of age) and the non-elderly groups (n = 130, <70 years of age).

Results

Between the two groups, sex, past medical history (hypertension and diabetes), body mass index, tumor characteristics (number, location, shape, maximal and circumferential size of the tumor and the resected specimen, and depth), and use of stricture prevention except for age (elderly vs non-elderly; 74.1 ± 2.78 vs. 61.1 ± 6.06 years, p < 0.001) did not differ. En bloc resection (elderly vs. non-elderly; 93.5 vs. 93.8%, p = 1.000), complete resection (elderly vs. non-elderly; 69.6 vs. 76.2%, p = 0.433), and curative resection rates (elderly vs. non-elderly; 54.3 vs. 60.0%, p = 0.602) did not differ significantly between the two groups. Procedure time and hospital stay were also similar between the two groups. Complications of ESD such as stricture (17.4 vs. 10.8%, p = 0.299) and perforation (13.0 vs. 6.2%, p = 0.083) occurred at a similar rate in the elderly and non-elderly groups. After curative ESD, cumulative recurrence rate of the elderly group (0%) did not differ significantly to that of the non-elderly group (5.1%) by the log-rank test (p = 0.307).

Conclusion

ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.

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References

  1. Zhang Y (2013) Epidemiology of esophageal cancer. World J Gastroenterol 19:5598–5606

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mocanu A, Barla R, Hoara P, Constantinoiu S (2015) Current endoscopic methods of radical therapy in early esophageal cancer. J Med Life 8:150–156

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Sakai M, Kuwano H (2016) [Endoscopic therapy for esophageal cancer]. Kyobu Geka 69:718–723

    PubMed  Google Scholar 

  4. Choi LJ, Lee NR, Kim SG, Lee WS, Park SJ, Kim JJ, Lee JH, Kwon JW, Park SH, You JH, Kim JH, Lim CH, Cho JY, Kim GH, Lee YC, Jung HY, Kim JY, Chun HJ, Seol SY (2016) Short-term outcomes of endoscopic submucosal dissection in patients with early gastric cancer: A prospective multicenter cohort study. Gut Liver 10:739–748

    Article  PubMed  PubMed Central  Google Scholar 

  5. Min BH, Kim ER, Kim KM, Park CK, Lee JH, Rhee PL, Kim JJ (2015) Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer. Endoscopy 47:784–793

    Article  PubMed  Google Scholar 

  6. Pyo JH, Lee H, Min BH, Lee JH, Choi MG, Lee JH, Sohn TS, Bae JM, Kim KM, Ahn JH, Carriere KC, Kim JJ, Kim S (2016) Long-term outcome of endoscopic resection vs. surgery for early gastric cancer: a non-inferiority-matched cohort study. Am J Gastroenterol 111:240–249

    Article  PubMed  Google Scholar 

  7. Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, Shikuwa S (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22:311–317

    Article  PubMed  Google Scholar 

  8. Kato M, Michida T, Kusakabe A, Sakai A, Hibino C, Kato M, Tokuda Y, Kawai T, Hamano M, Chiba M, Maeda K, Yamamoto K, Naito M, Ito T (2016) Safety and short-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients. Endosc Int Open 4:E521–526

    Article  PubMed  PubMed Central  Google Scholar 

  9. Toyokawa T, Fujita I, Morikawa T, Okamoto A, Miyasaka R, Watanabe K, Horii J, Gobaru M, Terao M, Murakami T, Tomoda J (2011) Clinical outcomes of ESD for early gastric neoplasms in elderly patients. Eur J Clin Invest 41:474–478

    Article  PubMed  Google Scholar 

  10. Kim JS, Kim BW, Shin IS (2014) Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci 59:1862–1869

    Article  PubMed  Google Scholar 

  11. Park JS, Youn YH, Park JJ, Kim JH, Park H (2016) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc 49:168–175

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pech O, May A, Gossner L, Rabenstein T, Manner H, Huijsmans J, Vieth M, Stolte M, Berres M, Ell C (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39:30–35

    Article  CAS  PubMed  Google Scholar 

  13. Probst A, Aust D, Markl B, Anthuber M, Messmann H (2015) Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 47:113–121

    PubMed  Google Scholar 

  14. Repici A, Hassan C, Carlino A, Pagano N, Zullo A, Rando G, Strangio G, Romeo F, Nicita R, Rosati R, Malesci A (2010) Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 71:715–721

    Article  PubMed  Google Scholar 

  15. Sun F, Yuan P, Chen T, Hu J (2014) Efficacy and complication of endoscopic submucosal dissection for superficial esophageal carcinoma: a systematic review and meta-analysis. J Cardiothorac Surg 9:78–87

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Tsujii Y, Nishida T, Nishiyama O, Yamamoto K, Kawai N, Yamaguchi S, Yamada T, Yoshio T, Kitamura S, Nakamura T, Nishihara A, Ogiyama H, Nakahara M, Komori M, Kato M, Hayashi Y, Shinzaki S, Iijima H, Michida T, Tsujii M, Takehara T (2015) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 47:775–783

    Article  PubMed  Google Scholar 

  17. Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, D’Amico TA (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78:1170–1176

    Article  PubMed  Google Scholar 

  18. Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coebergh JW, Weeks JC, Earle CC (2006) Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 24:4277–4284

    Article  PubMed  Google Scholar 

  19. Kikuchi O, Mouri H, Matsueda K, Yamamoto H (2012) Endoscopic submucosal dissection for treatment of patients aged 75 years and over with esophageal cancer. ISRN Gastroenterol 2012:671324

    Article  PubMed  PubMed Central  Google Scholar 

  20. Peng C, Shen S, Xu G, Lv Y, Zhang X, Ling T, Wang L, Ding X, Zou X (2016) Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms. United Eur Gastroenterol J 4:242–249

    Article  CAS  Google Scholar 

  21. Iizuka T, Kikuchi D, Yamada A, Hoteya S, Kajiyama Y, Kaise M (2015) Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy 47:341–344

    PubMed  Google Scholar 

  22. Kataoka M, Anzai S, Shirasaki T, Ikemiyagi H, Fujii T, Mabuchi K, Suzuki S, Yoshida M, Kawai T, Kitajima M (2015) Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer. Endosc Int Open 3:E113–117

    PubMed  Google Scholar 

  23. Wang W, Ma Z (2015) Steroid administration is effective to prevent strictures after endoscopic esophageal submucosal dissection: a network meta-analysis. Medicine (Baltimore) 94:e1664

    Article  CAS  Google Scholar 

  24. Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol 17:1721–1724

    Article  PubMed  Google Scholar 

  25. Endoscopic Classification Review Group (2005) Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578

    Article  Google Scholar 

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    Authors and Affiliations

    1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

      Byeong Geun Song, Yang Won Min, Jun Haeng Lee, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee & Jae J. Kim

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    1. Byeong Geun Song
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    2. Yang Won Min
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    Correspondence to Jun Haeng Lee.

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    Dr. Byeong Geun Song, Yang Won Min, Jun Haeng Lee, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee, and Jae J. Kim have no conflicts of interest or financial ties to disclose.

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    Byeong Geun Song and Yang Won Min have contributed equally to this work.

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    Song, B.G., Min, Y.W., Lee, J.H. et al. Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma. Surg Endosc 31, 3905–3911 (2017). https://doi.org/10.1007/s00464-017-5421-4

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    • DOI: https://doi.org/10.1007/s00464-017-5421-4

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