Outcome of endoscopic submucosal dissection for colorectal  tumors in elderly people.
BACKGROUND
Endoscopic submucosal dissection (ESD) has been reported to be effective for the en bloc resection of large colorectal tumors. Our study investigated whether ESD was suitable for elderly people with large colorectal tumors in terms of its invasiveness.


METHODS
We studied 119 colorectal tumors that were treated with ESD at Kyoto Prefectural University of Medicine or Nara City Hospital between 2006 and 2009. We classified each patient as either elderly, i.e., more than 75 years old, or non-elderly, i.e., less than 75 years old. Thirty-two of the cases were classified as elderly. Performance status, tumor size, operation time, rate of en bloc resection, histopathological diagnosis, complications, and hospital stay after ESD were analyzed retrospectively in both groups.


RESULTS
In the elderly group, the average tumor size was 32.6 mm; the average operation time, 96 min; the rate of en bloc resection, 81.2%; the rate of perforation, 3.1%; and hospital stay after ESD, 5.1 days. Histopathological diagnosis for 16 tumors was adenoma; for 13, carcinoma with invasion into the mucosa; and for three, carcinoma with invasion into the submucosa. There were no statistical differences between the two groups in any of these data. The case with perforation was treated conservatively without urgent surgery in the elderly group.


CONCLUSIONS
ESD for colorectal tumors resulted in favorable rates of en bloc resection in elderly people. Perforation occurred in elderly people, but these patients were cured with conservative treatment. ESD is a safe and minimally invasive treatment for elderly people with colorectal tumors.
Yoshida
Naohisa
N
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. naohisa@koto.kpu-m.ac.jp
Naito
Yuji
Y
Sakai
Kyoko
K
Sumida
Yoshio
Y
Kanemasa
Kazuyuki
K
Inoue
Ken
K
Morimoto
Yasutaka
Y
Konishi
Hideyuki
H
Wakabayashi
Naoki
N
Kokura
Satoshi
S
Yagi
Nobuaki
N
Yanagisawa
Akio
A
Yoshikawa
Toshikazu
T
D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects / Q000592:standards*; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004210:Dissection; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D010535:Laparoscopy; D007902:Length of Stay; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden