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Comparison of endoscopic submucosal dissection and surgery for early gastric cancer that is not indicated for endoscopic resection in elderly patients

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Abstract

Background

Endoscopic submucosal dissection (ESD) is sometimes performed for early gastric cancer (EGC) which is not indicated for endoscopic resection (ER) in elderly patients considering old age and comorbidities. We aimed to compare outcomes between ESD and surgery in elderly patients with EGC that is not indicated for ER.

Methods

Elderly patients aged ≥ 75 years who underwent either ESD or surgery for EGC which was not indicated for ER between 2005 and 2015 were retrospectively investigated.

Results

Among a total of 294 patients, 59 (20.1%) and 235 (79.9%) patients underwent ESD and surgery as the initial treatment, respectively. The ESD group had smaller size of tumors (25 vs. 30 mm, p = .001) and higher rate of differentiated-type cancer than the surgery group had (88.1% vs. 60.9%, p = 0.001). With a median observation period of 91.8 months (range 11.6–198.1 months), 141 (48.0%) patients died: 25 (42.4%) and 116 (49.4%) patients in the ESD group and the surgery group, respectively. Overall survival and disease-free survival between the two groups had no significant differences (p = 0.982. p = 0.155, respectively).

Conclusions

ESD may be an alternative option for EGC which is not indicated for ER in elderly patients aged ≥ 75 years, considering old age and comorbidity.

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References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin 71:209–249

    PubMed  Google Scholar 

  2. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD study group multicenter study. Gastrointest Endosc 69:1228–1235

    Article  PubMed  Google Scholar 

  3. Kim SG, Lyu DH, Park CM, Lee NR, Kim J, Cha Y, Jung HY (2019) Current status of endoscopic submucosal dissection for early gastric cancer in Korea: role and benefits. Korean J Intern Med 34:785–793

    Article  PubMed  Google Scholar 

  4. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  5. Nishizawa T, Yahagi N (2018) Long-term outcomes of using endoscopic submucosal dissection to treat early gastric cancer. Gut Liver 12:119–124

    Article  PubMed  Google Scholar 

  6. Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, Esposito G, Lemmers A, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten B, van Hooft JE, Deprez PH, Dinis-Ribeiro M (2022) Endoscopic submucosal dissection for superficial gastrointestinal lesions: European society of gastrointestinal endoscopy (ESGE) guideline—update 2022. Endoscopy 54:591–622

    Article  PubMed  Google Scholar 

  7. Ono H, Yao K, Fujishiro M, Oda I, Uedo N, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Fujimoto K (2021) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc 33:4–20

    Article  PubMed  Google Scholar 

  8. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24:1–21

    Article  Google Scholar 

  9. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel (2019) Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer 19:1–48

    Article  Google Scholar 

  10. Wang FH, Zhang XT, Li YF, Tang L, Qu XJ, Ying JE, Zhang J, Sun LY, Lin RB, Qiu H, Wang C, Qiu MZ, Cai MY, Wu Q, Liu H, Guan WL, Zhou AP, Zhang YJ, Liu TS, Bi F, Yuan XL, Rao SX, Xin Y, Sheng WQ, Xu HM, Li GX, Ji JF, Zhou ZW, Liang H, Zhang YQ, Jin J, Shen L, Li J, Xu RH (2021) The Chinese society of clinical oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (London) 41:747–795

    Article  Google Scholar 

  11. Nunobe S, Oda I, Ishikawa T, Akazawa K, Katai H, Isobe Y, Miyashiro I, Tsujitani S, Ono H, Tanabe S, Fukagawa T, Suzuki S, Kakeji Y (2020) Surgical outcomes of elderly patients with Stage I gastric cancer from the nationwide registry of the Japanese gastric cancer association. Gastric Cancer 23:328–338

    Article  PubMed  Google Scholar 

  12. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, Shimada H (2006) Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients. Am J Surg 191:216–224

    Article  PubMed  Google Scholar 

  13. Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005

    CAS  PubMed  Google Scholar 

  14. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, Rodriguez F, Fernandez G (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20:38–45

    CAS  PubMed  Google Scholar 

  15. Bosman F, Carneiro F, Hruban R, Theise N (2010) WHO classification of tumours of the digestive system, 4th edn. IARC Press, Lyon

    Google Scholar 

  16. Akasaka T, Nishida T, Tsutsui S, Michida T, Yamada T, Ogiyama H, Kitamura S, Ichiba M, Komori M, Nishiyama O, Nakanishi F, Zushi S, Nishihara A, Iijima H, Tsujii M, Hayashi N (2011) Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by osaka university ESD study group. Dig Endosc 23:73–77

    Article  PubMed  Google Scholar 

  17. Park CH, Lee H, Kim DW, Chung H, Park JC, Shin SK, Hyung WJ, Lee SK, Lee YC, Noh SH (2014) Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc 80:599–609

    Article  PubMed  Google Scholar 

  18. Li H, Feng LQ, Bian YY, Yang LL, Liu DX, Huo ZB, Zeng L (2019) Comparison of endoscopic submucosal dissection with surgical gastrectomy for early gastric cancer: an updated meta-analysis. World J Gastrointest Oncol 11:161–171

    Article  PubMed  PubMed Central  Google Scholar 

  19. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D (2016) Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 27:v38–v49

    Article  CAS  PubMed  Google Scholar 

  20. Inokuchi Y, Ishida A, Hayashi K, Kaneta Y, Watanabe H, Kano K, Furuta M, Takahashi K, Fujikawa H, Yamada T, Yamamoto K, Machida N, Ogata T, Oshima T, Maeda S (2022) Feasibility of gastric endoscopic submucosal dissection in elderly patients aged ≥ 80 years. World J Gastrointest Endosc 14:49–62

    Article  PubMed  PubMed Central  Google Scholar 

  21. Toya Y, Endo M, Nakamura S, Akasaka R, Yanai S, Kawasaki K, Koeda K, Eizuka M, Fujita Y, Uesugi N, Ishida K, Sugai T, Matsumoto T (2019) Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years. Gastric Cancer 22:838–844

    Article  PubMed  Google Scholar 

  22. 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 15:70–75

    Article  PubMed  Google Scholar 

  23. Yoshifuku Y, Oka S, Tanaka S, Sanomura Y, Miwata T, Numata N, Hiyama T, Chayama K (2016) Long-term prognosis after endoscopic submucosal dissection for early gastric cancer in super-elderly patients. Surg Endosc 30:4321–4329

    Article  PubMed  Google Scholar 

  24. Sekiguchi M, Oda I, Suzuki H, Abe S, Nonaka S, Yoshinaga S, Taniguchi H, Sekine S, Saito Y (2017) Clinical outcomes and prognostic factors in gastric cancer patients aged ≥85 years undergoing endoscopic submucosal dissection. Gastrointest Endosc 85:963–972

    Article  PubMed  Google Scholar 

  25. Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Ichinose M, Matsui T (2016) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 28:3–15

    Article  PubMed  Google Scholar 

  26. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  27. Kishida Y, Takizawa K, Kakushima N, Kawata N, Yoshida M, Yabuuchi Y, Yamamoto Y, Ito S, Imai K, Hotta K, Ishiwatari H, Matsubayashi H, Bando E, Terashima M, Ono H (2022) Endoscopic submucosal dissection versus surgery in elderly patients with early gastric cancer of relative indication for endoscopic resection. Dig Endosc 34:497–507

    Article  PubMed  Google Scholar 

  28. Toya Y, Endo M, Akasaka R, Morishita T, Yanai S, Nakamura S, Eizuka M, Sugimoto R, Uesugi N, Sugai T, Matsumoto T (2021) Prognostic nutritional index is an independent prognostic factor for older patients aged ≥ 85 years treated by gastric endoscopic submucosal dissection. BMC Gastroenterol 21:328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Watanabe M, Iwatsuki M, Iwagami S, Ishimoto T, Baba Y, Baba H (2012) Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg 36:1632–1639

    Article  PubMed  Google Scholar 

  30. Zhang X, Fang H, Zeng Z, Zhang K, Lin Z, Deng G, Deng W, Guan L, Wei X, Li X, Jiang L, Xu L (2021) Preoperative prognostic nutrition index as a prognostic indicator of survival in elderly patients undergoing gastric cancer surgery. Cancer Manag Res 13:5263–5273

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sugawara K, Aikou S, Yajima S, Uemura Y, Okumura Y, Nishida M, Yagi K, Yamashita H, Seto Y (2020) Pre- and post-operative low prognostic nutritional index influences survival in older patients with gastric carcinoma. J Geriatr Oncol 11:989–996

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Korea

    Seokin Kang, Jeong Hoon Lee, Yuri Kim, Kwangbeom Park, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Hwoon-Yong Jung

  2. Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

    Seokin Kang

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  1. Seokin Kang
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Correspondence to Jeong Hoon Lee.

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Drs. Seokin Kang, Jeong Hoon Lee, Yuri Kim, Kwangbeom Park, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, and Hwoon-Yong Jung have no potential conflicts of interest or financial ties to disclose.

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Kang, S., Lee, J.H., Kim, Y. et al. Comparison of endoscopic submucosal dissection and surgery for early gastric cancer that is not indicated for endoscopic resection in elderly patients. Surg Endosc 37, 4766–4773 (2023). https://doi.org/10.1007/s00464-023-09989-6

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  • DOI: https://doi.org/10.1007/s00464-023-09989-6

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