title: Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older.
abstract: BACKGROUND
  Little information is available on the long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in patients of advanced age (≥80 years).
  
  
  METHODS
  A multicenter study was conducted at 10 Japanese institutions concerning their results for ESD. Data on 440 patients of advanced age (≥80 years) with EGC (470 lesions) were collected and reviewed. Early and long-term outcomes of ESD were assessed. We compared the overall survival rates between 3 patient groups, those with curative ESD, additional surgery after noncurative ESD, and nonsurgical follow-up after noncurative ESD.
  
  
  RESULTS
  Bleeding and perforation rates were 3.2 and 2.8%, respectively. Curative ESD was achieved in 366 of the 470 lesions (77.9%). Of the 104 patients with noncurative ESD, 12 patients (11.5%) underwent additional surgery and 91 patients (87.5%) were followed without surgery. The 5-year survival rate in the patients with nonsurgical follow-up after noncurative ESD (66.7%) was significantly lower than that in the patients with curative ESD (80.3%, p = 0.0001). There was no significant difference in the 5-year survival rates between the patients with curative ESD and those with surgery after noncurative ESD (100%, p = 0.21), nor was there a difference in these rates between the patients with surgery after noncurative ESD and those with nonsurgical follow-up after noncurative ESD (p = 0.061). None of the patients developed cancer recurrence after curative ESD, and none developed cancer recurrence following the additional surgery after noncurative ESD. In the patients with curative ESD and in those with surgery after noncurative ESD, the cumulative observed survival was better than the expected survival for the general population of similar age and gender.
  
  
  CONCLUSIONS
  ESD is safe for the treatment of EGC in patients 80 years of age or older. Both curative ESD and additional surgery after noncurative ESD may contribute to the extension of life expectancy.
authors.affiliation: Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan. abenbtg@ks.kyorin-u.ac.jp
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hirasawa
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Kenji
authors.initials: K
authors.lastname: Ishido
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Imaeda
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishii
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kokawa
authors.forename: Chika
authors.initials: C
authors.lastname: Kusano
authors.forename: Tadateru
authors.initials: T
authors.lastname: Maehata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D055088:Early Detection of Cancer; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome