title: Treatment of early gastric cancer in the elderly patient: results of EMR and gastrectomy at a national referral center in Japan.
abstract: BACKGROUND
  The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cancer in the population is decreasing. The optimal treatment for these patients remains a challenge to the surgeon. The aim of this retrospective analysis was to describe the results of gastrectomy and EMR for early gastric cancer in elderly patients (80 years of age and over).
  
  
  METHODS
  This is a retrospective review of 93 elderly patients who had undergone gastrectomy or EMR at the National Cancer Center Hospital for early gastric cancer. EMR was performed aiming en bloc local resection with a clear curative margin (R0). The clinicopathologic characteristics, comorbidity, postoperative mortality, and outcome were recorded.
  
  
  RESULTS
  Gastrectomy was performed in 44 patients (surgery group) and EMR in 49 patients (EMR group). There were significant differences in mean tumor size (p < 0.05), histologic type (p < 0.05), and depth of tumor invasion (p < 0.05) between the two groups. There was no significant difference in comorbidity between the two groups. No operative death was reported in either group. In the EMR group, 7 patients were reported to have recurrence of local disease and two patients died of advanced disease. There were no significant differences in the overall 3-year survival rate or the 5-year survival rate between the surgery group and EMR group (73.5% vs. 82.5% and 55.0% vs. 62.5%, respectively).
  
  
  CONCLUSIONS
  EMR (R0) resection was performed safely in the elderly, and the overall results were excellent, the same as the results with gastrectomy. Gastrectomy can still be performed if EMR is unsuccessful.
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Etoh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukagawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Kimio
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sasako
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D007564:Japan; D008297:Male; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome