Jeung Hui Pyo1, Hyuk Lee2, Byung-Hoon Min1, Jun Haeng Lee1, Kyoung-Mee Kim3, Heejin Yoo4, Soohyun Ahn4, Ji Yeong An5, Min Gew Choi5, Jun Ho Lee5, Tae Sung Sohn5, Jae Moon Bae5, Jae J Kim1, Sung Kim5. 1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. leehyuk@skku.edu. 3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 4. Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea. 5. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Abstract
BACKGROUND: Limited data exist that describe the long-term outcomes from additional surgery following non-curative endoscopic resection (ER) of early gastric cancer (EGC) in older people. This study aimed to determine the appropriate treatment strategy for these patients. METHODS: We analyzed data from 2895 patients who underwent ER for EGC, of whom 451 (15.6%) had non-curative resections followed by curative surgery or surveillance only. Of these patients, 138 were older (aged ≥70 years). We compared the long-term outcomes of the different treatment strategies in the older patients with non-curative resections for EGC, and the outcomes of each treatment strategy, with those in younger patients. RESULTS: The older patients underwent curative resections, non-curative resections with surgery, or non-curative resections with surveillance, and the 5-year disease-specific survival (DSS) rates were 100, 100, and 73%, respectively. There was a trend toward significance for DSS in favor of the non-curative resections with surgery group compared with the non-curative resections with surveillance-only group (p = 0.069). Among those who did not undergo additional surgery, the older patients had worse DSS than the younger patients, and patients who underwent additional surgery had better DSS, irrespective of their ages. Multivariable analysis adjusted for other-cause mortality generated similar results. Overall survival and recurrence-free survival did not differ according to treatment strategy, and perioperative morbidity and mortality did not differ significantly according to age. CONCLUSIONS: In older patients with non-curatively resected EGC, additional surgery demonstrated a trend toward better DSS, and perioperative complications did not increase significantly.
BACKGROUND: Limited data exist that describe the long-term outcomes from additional surgery following non-curative endoscopic resection (ER) of early gastric cancer (EGC) in older people. This study aimed to determine the appropriate treatment strategy for these patients. METHODS: We analyzed data from 2895 patients who underwent ER for EGC, of whom 451 (15.6%) had non-curative resections followed by curative surgery or surveillance only. Of these patients, 138 were older (aged ≥70 years). We compared the long-term outcomes of the different treatment strategies in the older patients with non-curative resections for EGC, and the outcomes of each treatment strategy, with those in younger patients. RESULTS: The older patients underwent curative resections, non-curative resections with surgery, or non-curative resections with surveillance, and the 5-year disease-specific survival (DSS) rates were 100, 100, and 73%, respectively. There was a trend toward significance for DSS in favor of the non-curative resections with surgery group compared with the non-curative resections with surveillance-only group (p = 0.069). Among those who did not undergo additional surgery, the older patients had worse DSS than the younger patients, and patients who underwent additional surgery had better DSS, irrespective of their ages. Multivariable analysis adjusted for other-cause mortality generated similar results. Overall survival and recurrence-free survival did not differ according to treatment strategy, and perioperative morbidity and mortality did not differ significantly according to age. CONCLUSIONS: In older patients with non-curatively resected EGC, additional surgery demonstrated a trend toward better DSS, and perioperative complications did not increase significantly.
Authors: Chan Hyuk Park; Dong-Hoon Yang; Jong Wook Kim; Jie-Hyun Kim; Ji Hyun Kim; Yang Won Min; Si Hyung Lee; Jung Ho Bae; Hyunsoo Chung; Kee Don Choi; Jun Chul Park; Hyuk Lee; Min-Seob Kwak; Bun Kim; Hyun Jung Lee; Hye Seung Lee; Miyoung Choi; Dong-Ah Park; Jong Yeul Lee; Jeong-Sik Byeon; Chan Guk Park; Joo Young Cho; Soo Teik Lee; Hoon Jai Chun Journal: Clin Endosc Date: 2020-03-30
Authors: Chan Hyuk Park; Dong-Hoon Yang; Jong Wook Kim; Jie-Hyun Kim; Ji Hyun Kim; Yang Won Min; Si Hyung Lee; Jung Ho Bae; Hyunsoo Chung; Kee Don Choi; Jun Chul Park; Hyuk Lee; Min-Seob Kwak; Bun Kim; Hyun Jung Lee; Hye Seung Lee; Miyoung Choi; Dong-Ah Park; Jong Yeul Lee; Jeong-Sik Byeon; Chan Guk Park; Joo Young Cho; Soo Teik Lee; Hoon Jai Chun Journal: Intest Res Date: 2020-10-13