Long-term prognosis after endoscopic submucosal dissection for early gastric cancer in super-elderly patients
- 595 Downloads
No previous study has confirmed the safety of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the super-elderly patient population. The current study aimed to evaluate the validity of ESD for EGC in super-elderly patients aged ≥85 years with comorbidities.
Our study group included 85 super-elderly patients (102 EGCs) who were diagnosed at Hiroshima University Hospital between April 2002 and October 2014. We evaluated the en bloc resection rates, R0 resection rates, complication rates, and prognosis in relation to the degree of comorbidities (group A–H, patients with high-risk comorbidities; group A–L, patients with low-risk comorbidities; group B, patients without comorbidities; and group C, patients followed without ESD).
The en bloc resection rates were 100, 96, and 100 % in groups A–H, A–L, and B, respectively. R0 resection rates were 94, 96, and 94 % in groups A–H, A–L, and B, respectively. There were no severe complications related to ESD. During the follow-up period, there was a significantly higher frequency of death in group A than in group B (p < 0.01), and there were no significant differences between groups A–H and A–L. However, there were no cases of death related to gastric cancer.
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.
KeywordsEarly gastric cancer Endoscopic submucosal dissection Super-elderly patients, comorbidities
Compliance with ethical standards
Yoshikazu Yoshifuku, Shiro Oka, Shinji Tanaka, Yoji Sanomura, Tomohiro Miwata, Norifumi Numata, Toru Hiyama and Kazuaki Chayama have no conflicts of interest or financial ties to disclose.
- 3.Miyamoto S, Muto M, Hamamoto Y, Boku N, Ohtsu A, Boda S, Yoshida M, Ohkuwa M, Hosokawa K, Tajiri H, Yoshida S (2002) A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 55:576–581CrossRefPubMedGoogle Scholar
- 15.Ministry of Health, Labour and Welfare. Comparison of the average life span. http://www.mhlw.go.jp/toukei/saikin/hw/life/life13/dl/life13-04.pdf
- 17.Ministry of Internal Affairs and Communications Statistics Bureau. Population estimates. http://www.stat.go.jp/data/jinsui/
- 18.Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, Japan Cancer Surveillance Research Group (2013) Cancer incidence and incidence rates in Japan in 2008 a study of 25 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 44:388–396CrossRefGoogle Scholar
- 19.Ministry of Health, Labour and Welfare (2007) Abridged life tables for Japan 2007. Statistics and Information Department, Minister’s Secretariat, TokyoGoogle Scholar
- 24.Ishii N, Uchida S, Itoh T, Horiki N, Matsuda M, Setoyama T, Suzuki S, Uemura M, Iizuka Y, Fukuda K, Suzuki K, Fujita Y (2010) Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients? Surg Endosc 24:2110–2119CrossRefPubMedGoogle Scholar
- 30.Fujimoto K, Fujishiro M, Katou M, Higuchi K, Iwakiri R, Sakamoto C, Uchiyama S, Kashiwagi A, Ogawa H, Murakami K, Mine T, Yoshino J, Kinoshita Y, Ichinose M, Matsui T, Japan Gastroenterological Endoscopy Society (2014) Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014(26):1–14CrossRefGoogle Scholar
- 31.Sanomura Y, Oka S, Tanaka S, Numata N, Higashiyama M, Kanao H, Yoshida S, Ueno Y, Chayama K (2014) Continued use of low-dose aspirin does not increase the risk of bleeding during or after endoscopic submucosal dissection for early gastric cancer. Gastric Cancer 17:489–496CrossRefPubMedGoogle Scholar
- 35.Numata N, Oka S, Tanaka S, Higashiyama M, Sanomura Y, Yoshida S, Arihiro K, Chayama K (2013) Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in patients with chronic kidney disease. J Gastroenterol Hepatol 28:1632–1637Google Scholar
- 37.Abe N, Gotoda T, Hirasawa T, Hoteya S, Ishido K, Ida Y, Imaeda H, Ishii E, Kokawa A, Kusano C, Maehata T, Ono S, Takeuchi H, Sugiyama M, Takahashi S (2012) Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older. Gastric Cancer 15:70–75CrossRefPubMedGoogle Scholar
- 40.Matsushita I, Hanai H, Kajimura M, Tamakoshi K, Nakajima T, Matsubayashi Y, Kanek E (2002) 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 35:29–34CrossRefPubMedGoogle Scholar