Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma
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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.
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).
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).
ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.
KeywordsEndoscopic submucosal dissection Elderly Esophageal squamous cell carcinoma Outcome
Compliance wih ethical standards
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.
- 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 10:739–748CrossRefPubMedPubMedCentralGoogle 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:E521–526CrossRefPubMedPubMedCentralGoogle 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 71:715–721CrossRefPubMedGoogle 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 47:775–783CrossRefPubMedGoogle 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:E113–117PubMedGoogle Scholar