title: Endoscopic submucosal dissection for early gastric cancer in very elderly patients age 85 or older.
abstract: Background and study aimsThe safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in very elderly patients remains unclear. The aim of this study was to evaluate the safety and efficacy of ESD for EGC in patients age 85 years and older.Patients and methodsPatients who underwent ESD for EGC between September 2003 and April 2015 were divided into 3 groups: the very elderly (≥ 85 years; 43 patients), the elderly (65 - 84 years; 511 patients), and the non-elderly ( ≤ 64 years; 161 patients). Adverse events (AEs) were used as the primary endpoint to assess the safety of ESD, and the ESD treatment outcomes (i. e.,en blocresection rate, completeen blocresection rate, and curative resection rate) and the overall survival rate after ESD were the secondary endpoints. These parameters were retrospectively evaluated in the 3 groups.ResultsThere were no significant differences in AEs (non-elderly, elderly, and very elderly: 7.3, 9.5, and 12.5 %, respectively,P= 0.491) or in theen blocresection and completeen blocresection rates among the three groups. However, there was a significant difference in the curative resection rates (non-elderly, elderly, and very elderly: 91.5, 84.1, and 77.1 %, respectively,P= 0.014). Regarding overall survival, there was a significant difference among the three groups (1-, 5-, and 10-year overall survival rates: non-elderly: 98.6, 90.2, and 74.7 %; elderly: 97.2, 86.2, and 61.9 %; and very elderly: 92.7, 66.8, and 34.4 %, respectively,P= 0.001). Moreover, the overall survival rate in the very elderly patients with cardiovascular disease was significantly lower than that in the very elderly patients without cardiovascular disease (P< 0.001).ConclusionsESD is an acceptable treatment for EGC in patients 85 years of age or older in terms of safety. However, the overall survival after ESD in the very elderly patients with cardiovascular disease was short.
authors.affiliation: Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
authors.forename: Takuto
authors.initials: T
authors.lastname: Hikichi
authors.affiliation: Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Waragai
authors.affiliation: Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Konno
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Asama
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Takasumi
authors.affiliation: Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Obara
authors.affiliation: Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ohira