title: Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis.
abstract: BACKGROUND
  Little is known about the clinical and oncologic outcomes of endoscopic submucosal dissection (ESD) compared with surgery in elderly patients with early gastric cancer (EGC).
  
  
  OBJECTIVE
  To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication.
  
  
  METHODS
  Retrospective study with propensity-matched analysis.
  
  
  METHODS
  University-affiliated tertiary-care hospital, Seoul, South Korea.
  
  
  METHODS
  A total of 518 patients 70 years of age or older with initial-onset EGC.
  
  
  METHODS
  ESD and surgery.
  
  
  METHODS
  Clinical outcomes, disease-free survival, and overall survival.
  
  
  RESULTS
  In a propensity-matched analysis of 132 pairs, the length of hospital stay of the ESD group was shorter than that of the surgery group (median [interquartile range], 4 [3-4] vs 9 [7-11] days; P < .001). Intensive care unit admission occurred in the surgery group only (7 patients [5.3%]). Two surgery-related deaths occurred in the surgery group (1 splenic artery bleeding and 1 anastomosis site leakage). During follow-up, metachronous lesions developed more often in the ESD group than in the surgery group (12 vs 2 lesions, P = .004). All recurred lesions were successfully treated endoscopically except for 3 patients who refused additional treatment. Overall survival did not differ between the 2 groups (P = .280).
  
  
  CONCLUSIONS
  Nonrandomized, retrospective study.
  
  
  CONCLUSIONS
  ESD is a safe procedure in elderly patients with EGC. Although the risk of metachronous lesions is higher in patients who undergo ESD than in those who undergo surgery, overall survival did not differ between the patients who undergo ESD and surgery.
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Chan Hyuk
authors: CH
authors: Park
authors: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Hyuk
authors: H
authors: Lee
authors: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.
authors: Dong Wook
authors: DW
authors: Kim
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Hyunsoo
authors: H
authors: Chung
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Jun Chul
authors: JC
authors: Park
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Sung Kwan
authors: SK
authors: Shin
authors: Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Woo Jin
authors: WJ
authors: Hyung
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Sang Kil
authors: SK
authors: Lee
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Yong Chan
authors: YC
authors: Lee
authors: Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Sung Hoon
authors: SH
authors: Noh
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D061214:Patient Safety; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome