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Prognosis after curative resection for stage IA gastric cancer in elderly patients: endoscopic submucosal dissection versus surgery

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Abstract

Purpose

To establish whether gastrectomy for early gastric cancer (EGC) in elderly patients is related to poor survival.

Methods

The subjects of this retrospective study were patients aged ≥ 75 years with primary stage IA EGC, who underwent curative resection with endoscopic submucosal dissection (ESD) or surgery.

Results

We analyzed data on 365 patients who underwent ESD and 170 patients who underwent surgery. Overall survival (OS) was not significantly different for the ESD group vs. the surgery group (5-year cumulative rates, 81.5% vs. 79.7%; log-rank test, P = 0.506). Multivariate analysis revealed that treatments; namely, ESD or surgery, were not associated with OS (hazard ratio 1.09, 95% confidence interval 0.77–1.51). Similar results were observed even in the subgroups with worse conditions, such as age > 80 years, Eastern Cooperative Oncology Group performance status 2–3, Charlson comorbidity index ≥ 2, and prognostic nutritional index ≤ 46.7. Using propensity score matching, we selected 88 pairs of patients who underwent ESD or surgery with baseline characteristics matched and found that OS was not different between the two groups (log-rank test, P = 0.829).

Conclusion

OS was comparable for elderly patients who underwent ESD and those who underwent surgery for EGC. Surgical invasiveness did not worsen the prognosis, even for elderly patients.

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Authors and Affiliations

  1. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Koji Miyahara, Tetsu Hirata, Yuka Obayashi, Tatsuhiro Gotoda, Yuki Ninomiya, Yuki Moritou & Masaki Kunihiro

  2. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Michihiro Ishida, Tetsushi Kubota, Yasuhiro Choda & Yasuhiro Shirakawa

  3. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Yoshiyasu Kono & Hiroyuki Okada

  4. Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Masahiro Nakagawa

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  1. Koji Miyahara
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Correspondence to Koji Miyahara.

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Miyahara, K., Ishida, M., Kono, Y. et al. Prognosis after curative resection for stage IA gastric cancer in elderly patients: endoscopic submucosal dissection versus surgery. Surg Today 52, 1329–1340 (2022). https://doi.org/10.1007/s00595-022-02456-0

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