title: Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) has been used recently for successful en bloc resection of even large lesions, although no consensus appears in medical literature concerning its application to elderly patients. This prospective cohort study aimed to evaluate the efficacy and safety of colorectal ESD for patients 80 years of age or older.
  
  
  METHODS
  Colorectal ESD procedure findings were compared with clinical outcomes, including associated complications and mortalities, for two age groups totaling 196 consecutive patients with 202 colorectal lesions. Of the 196 patients, 31 patients (16%) were 80 years of age or older (group E), and 165 patients (84%) were younger than 80 years (group Y).
  
  
  RESULTS
  The median ages were 82 years in group E and 68 years in group Y. The frequency of chronic concomitant diseases was significantly higher in group E (65%) than in group Y (27%) (p = 0.003). No significant pressure decrease or need for oxygenation was observed in either group. In addition, groups E and Y did not differ significantly in terms of mean lesion sizes (40.9 vs. 39.7 mm) en bloc resection rates (84% vs. 93%), curative rates (78% vs. 84%), median procedure times (65 vs. 70 min), or associated complications (no perforation or delayed bleeding cases [0%] vs. 5 perforations [3%]) The median postprocedure hospitalization period was 3 days in both groups. Except for 10 cases requiring subsequent lymph node dissection surgery, follow-up colonoscopy examinations showed no recurrences or ESD-related mortalities in either group.
  
  
  CONCLUSIONS
  Colorectal ESD is a safe and effective treatment for elderly patients (age ≥ 80 years) despite a significantly higher frequency of chronic concomitant diseases than among younger patients.
authors.affiliation: Department of Endoscopy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. turaoka@md.okayama-u.ac.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Reiji
authors.initials: R
authors.lastname: Higashi
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kaji
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shin
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Akita
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hirakawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mead
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D004210:Dissection; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D007431:Intraoperative Complications / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies