title: Endoscopic mucosal resection in elderly patients.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) of early superficial colorectal carcinomas is nowadays accepted as the gold standard treatment for this type of neoplasia.
  
  
  OBJECTIVE
  This study aims to evaluate the efficacy and safety of mucosectomy in elderly patients considering the predictive value of submucosal infiltration.
  
  
  METHODS
  A retrospective study of all patients referred for EMR of sessile colorectal polyps classified IIa by the Paris classification between April 2013 and April 2015. A total of 50 patients (30 males (60 %); age range = 44-86; mean age = 67.7) were enrolled. Patients were divided in two groups considering 65 years as cutoff to individuate the elderly patients.
  
  
  RESULTS
  EMR was performed in 53 lesions: 39 were performed en bloc and 14 by piecemeal technique. 30 % of lesions were in the rectum; 11 % in the sigmoid colon; 15 % in the descending colon; 6 % in the transverse colon; 24 % in the ascendant colon; and 14 % in the cecum. The mean size of the resected specimens was 20 mm (range 8-80 mm). The rate of complete resection was 79.2 %, incomplete 13.2 %, not estimable 7 %. Ten patients underwent surgery because of an incomplete resection and/or histological evaluation.
  
  
  CONCLUSIONS
  Colon EMR is safe and effective in elderly patients. Endoscopy is still helped in the correct indication for surgery in high-risk surgical patients.
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy. stefano.pontone@uniroma1.it.
authors.forename: Stefano
authors.identifier: http://orcid.org/0000-0001-7148-3220
authors.initials: S
authors.lastname: Pontone
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Palma
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Panetta
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pironi
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Eberspacher
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Angelini
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pontone
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Catania
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Filippini
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sorrenti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Colonoscopy; Colorectal cancer; Elderly patients; Endoscopic resection; Lifting sign; Polyp; Submucosal invasion