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Safety and usefulness of endoscopic submucosal dissection for early esophageal cancers in elderly patients aged 80 years or older

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Abstract

Background and aim

Endoscopic submucosal dissection (ESD) for early gastrointestinal (GI) cancers is widely performed as a standard treatment in Japan. Given the increasing life expectancy worldwide, it is naturally regarded that the rate of elderly patients diagnosed with early GI cancer has increased. Available guidelines do not specifically outline how to manage endoscopic therapy for the elderly. The aim of this study was to assess the safety and usefulness of ESD for superficial esophageal squamous cell carcinoma (SESCC) in elderly patients.

Methods

We retrospectively investigated 393 consecutive patients, who underwent 426 ESD for 444 SESCCs from January 2011 to August 2016 at our institution. For this study, patients were divided into 2 groups based on their age; ≥ 80 years (Group aged ≥ 80 years, n = 42) and < 80 years (group aged < 80 years, n = 351). Patient demographics, sedation methods, technical outcomes, adverse events, sedatives, dosages given, overall survival, and disease-specific survival were then examined.

Results

The ESD procedure time was significantly longer for group aged ≥ 80 years than for group aged < 80 years (110 min [range 29–260] vs 85 min [24–504], p = 0.006); however, there was no significant differences between other technical items and adverse events. The 3-year overall survival and disease-specific survival were favorable in both groups.

Conclusions

Esophageal ESD for elderly patients aged ≥ 80 years can be safely performed. Mid-term outcome was favorable. Our study suggests that esophageal ESD might be a useful treatment for SESCCs.

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Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yasuo Miyamoto, Satoru Nonaka, Ichiro Oda, Seiichiro Abe, Haruhisa Suzuki, Shigetaka Yoshinaga & Yutaka Saito

  2. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Yasuo Miyamoto & Hiroyuki Mano

  3. Department of Gastroenterology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan

    Yasuo Miyamoto

  4. National Cancer Center Research Institute, Tokyo, Japan

    Hiroyuki Mano

Authors
  1. Yasuo Miyamoto
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  2. Satoru Nonaka
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  3. Ichiro Oda
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  4. Seiichiro Abe
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  5. Haruhisa Suzuki
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  6. Shigetaka Yoshinaga
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  7. Hiroyuki Mano
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  8. Yutaka Saito
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Correspondence to Satoru Nonaka.

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Ethical Statement

This study adhered to the ethical principles of the Declaration of Helsinki and was approved by the institutional review board of our institution.

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10388_2020_750_MOESM1_ESM.jpg

Figure 3 Metachronous cancer of the esophagus and head & neck. There is no significant difference between group aged ?80 years and group aged <80 years using Kaplan–Meier estimates (JPG 74 kb)

Supplementary file2 (DOCX 28 kb)

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Miyamoto, Y., Nonaka, S., Oda, I. et al. Safety and usefulness of endoscopic submucosal dissection for early esophageal cancers in elderly patients aged 80 years or older. Esophagus 18, 81–89 (2021). https://doi.org/10.1007/s10388-020-00750-9

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  • DOI: https://doi.org/10.1007/s10388-020-00750-9

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