Chan Hyuk Park1, Hyuk Lee2, Dong Wook Kim3, Hyunsoo Chung1, Jun Chul Park1, Sung Kwan Shin1, Woo Jin Hyung4, Sang Kil Lee1, Yong Chan Lee1, Sung Hoon Noh4. 1. Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea. 2. Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea. 4. Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
Abstract
BACKGROUND: Little is known about the clinical and oncologic outcomes of endoscopic submucosal dissection (ESD) compared with surgery in elderly patients with early gastric cancer (EGC). OBJECTIVE: To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. DESIGN: Retrospective study with propensity-matched analysis. SETTING: University-affiliated tertiary-care hospital, Seoul, South Korea. PATIENTS: A total of 518 patients 70 years of age or older with initial-onset EGC. INTERVENTIONS: ESD and surgery. MAIN OUTCOME MEASUREMENTS: Clinical outcomes, disease-free survival, and overall survival. RESULTS: In a propensity-matched analysis of 132 pairs, the length of hospital stay of the ESD group was shorter than that of the surgery group (median [interquartile range], 4 [3-4] vs 9 [7-11] days; P < .001). Intensive care unit admission occurred in the surgery group only (7 patients [5.3%]). Two surgery-related deaths occurred in the surgery group (1 splenic artery bleeding and 1 anastomosis site leakage). During follow-up, metachronous lesions developed more often in the ESD group than in the surgery group (12 vs 2 lesions, P = .004). All recurred lesions were successfully treated endoscopically except for 3 patients who refused additional treatment. Overall survival did not differ between the 2 groups (P = .280). LIMITATIONS: Nonrandomized, retrospective study. CONCLUSIONS: ESD is a safe procedure in elderly patients with EGC. Although the risk of metachronous lesions is higher in patients who undergo ESD than in those who undergo surgery, overall survival did not differ between the patients who undergo ESD and surgery.
BACKGROUND: Little is known about the clinical and oncologic outcomes of endoscopic submucosal dissection (ESD) compared with surgery in elderly patients with early gastric cancer (EGC). OBJECTIVE: To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. DESIGN: Retrospective study with propensity-matched analysis. SETTING: University-affiliated tertiary-care hospital, Seoul, South Korea. PATIENTS: A total of 518 patients 70 years of age or older with initial-onset EGC. INTERVENTIONS: ESD and surgery. MAIN OUTCOME MEASUREMENTS: Clinical outcomes, disease-free survival, and overall survival. RESULTS: In a propensity-matched analysis of 132 pairs, the length of hospital stay of the ESD group was shorter than that of the surgery group (median [interquartile range], 4 [3-4] vs 9 [7-11] days; P < .001). Intensive care unit admission occurred in the surgery group only (7 patients [5.3%]). Two surgery-related deaths occurred in the surgery group (1 splenic artery bleeding and 1 anastomosis site leakage). During follow-up, metachronous lesions developed more often in the ESD group than in the surgery group (12 vs 2 lesions, P = .004). All recurred lesions were successfully treated endoscopically except for 3 patients who refused additional treatment. Overall survival did not differ between the 2 groups (P = .280). LIMITATIONS: Nonrandomized, retrospective study. CONCLUSIONS: ESD is a safe procedure in elderly patients with EGC. Although the risk of metachronous lesions is higher in patients who undergo ESD than in those who undergo surgery, overall survival did not differ between the patients who undergo ESD and surgery.
Authors: R Bausys; A Bausys; J Stanaitis; I Vysniauskaite; K Maneikis; B Bausys; E Stratilatovas; K Strupas Journal: Surg Endosc Date: 2018-12-03 Impact factor: 4.584