[Indications for endoscopic treatment of early gastric cancer in the aged].
There are few data on the quality of life of patients with early gastric cancer before and after surgery or endoscopic treatment. We reported the long term effect of endoscopic laser therapy as a local curative procedure and discussed appropriate treatment of choice for early gastric cancer in the aged more than 70 years old based on the results of a comparative study of a group of 56 endoscopically treated group of patients and a group of 57 surgically treated patients. Fifty-six patients with endoscopically diagnosed early gastric cancer whose surgical risk was critical or who refused surgery were treated by either photocoagulative effect of Nd:YAG laser or photodynamic therapy with hematoporphyrin derivative and argon dye laser (PDT) or both. The efficacy (negative biopsy for cancer) of laser therapy is 73% at present. All the lesions of superficially elevated mucosal cancer less than 20mm and well demarcated flat or superficially depressed mucosal cancer less than 10 mm (10 elevated lesions, 8 flat or depressed lesions) were completely eradicated and negative for cancer on follow-up biopsy for more than 12 months. Risks of lymph-node metastasis in these lesions are reportedly negligible. Fourteen of the 56 patients (25%) treated by lasers died within 5 years after the initial therapy. Two of them died of gastric cancers too large to eradicate and were presumed to have submucosal invasion. On the other hand, 11 of 57 (19%) treated by surgery died within 5 years following surgery. One patient died from surgery and another of gastric cancer. Quality of life score did not decrease when the patients were treated by lasers but did so statistically significantly in the surgically treated group of patients. Although surgical death in the aged has decreased, death associated with surgical complications is significantly higher than with patients younger than 69 years old. Therefore, we conclude that endoscopic therapy is the treatment of choice for early gastric cancer as a local curative procedure in the aged, if they have a curable lesion as mentioned above.
Ito
Y
Y
Dept. of Endoscopy, Aichi Cancer Center Hospital.
Kano
T
T
D000368:Aged; D005773:Gastroscopy; D006801:Humans; D053685:Laser Therapy; D010778:Photochemotherapy; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*