Mitsuru Esaki1,2, Waku Hatta3, Tooru Shimosegawa4, Tsuneo Oyama5, Noboru Kawata6, Akiko Takahashi5, Shiro Oka7, Shu Hoteya8, Masahiro Nakagawa9, Masaaki Hirano10, Mitsuru Matsuda11, Ken Ohnita12, Ryo Shimoda13, Motoyuki Yoshida14, Osamu Dohi15, Jun Takada16, Keiko Tanaka17, Shinya Yamada18, Tsuyotoshi Tsuji19, Hirotaka Ito20, Hiroyuki Aoyagi21, Takuji Gotoda1. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 2. Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 3. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan, waku-style@festa.ocn.ne.jp. 4. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 5. Division of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan. 6. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 7. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan. 8. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. 9. Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan. 10. Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan. 11. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan. 12. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 13. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 14. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Nara, Japan. 15. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 16. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan. 17. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan. 18. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 19. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 20. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 21. Division of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan.
Abstract
BACKGROUND: Additional surgery is recommended after noncurative endoscopic submucosal dissection (ESD) for early gastric cancer due to the risk of lymph node metastasis. However, age may affect the clinical management of these patients. OBJECTIVES: The aim of our retrospective multicenter study was to clarify whether age affects decision-making after noncurative ESD and if the decision affects long-term outcomes. METHODS: Age was classified as follows: non-elderly, <70 years (n = 811); elderly, 70-79 years (n= 760); and super-elderly, ≥80 years (n = 398). Age associations with the selection for additional surgery were evaluated using logistic regression analysis. Long-term outcomes were also evaluated in each age group. RESULTS: Age was inversely related to the rate of additional surgery, which ranged from 70.0% in the non-elderly group to 20.1% in the super-elderly group (p < 0.001). On multivariate analysis, age <70 years (versus age ≥80 years) was associated with the -selection of additional surgery (OR 18.6). Overall survival (OS) in patients who underwent additional surgery was -significantly higher in the non-elderly and elderly groups (p< 0.001), whereas the difference was not significant in the super-elderly group (p = 0.23). CONCLUSIONS: Despite the fact that almost 80% of super-elderly patients did not undergo additional surgery, the difference of OS between patients with and without additional surgery was not significant only in patients ≥80 years. Therefore, establishment of criteria for selecting treatment methods after noncurative ESD in elderly patients is required.
BACKGROUND: Additional surgery is recommended after noncurative endoscopic submucosal dissection (ESD) for early gastric cancer due to the risk of lymph node metastasis. However, age may affect the clinical management of these patients. OBJECTIVES: The aim of our retrospective multicenter study was to clarify whether age affects decision-making after noncurative ESD and if the decision affects long-term outcomes. METHODS:Age was classified as follows: non-elderly, <70 years (n = 811); elderly, 70-79 years (n= 760); and super-elderly, ≥80 years (n = 398). Age associations with the selection for additional surgery were evaluated using logistic regression analysis. Long-term outcomes were also evaluated in each age group. RESULTS:Age was inversely related to the rate of additional surgery, which ranged from 70.0% in the non-elderly group to 20.1% in the super-elderly group (p < 0.001). On multivariate analysis, age <70 years (versus age ≥80 years) was associated with the -selection of additional surgery (OR 18.6). Overall survival (OS) in patients who underwent additional surgery was -significantly higher in the non-elderly and elderly groups (p< 0.001), whereas the difference was not significant in the super-elderly group (p = 0.23). CONCLUSIONS: Despite the fact that almost 80% of super-elderly patients did not undergo additional surgery, the difference of OS between patients with and without additional surgery was not significant only in patients ≥80 years. Therefore, establishment of criteria for selecting treatment methods after noncurative ESD in elderly patients is required.