Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2022; 14(1): 49-62
Published online Jan 16, 2022. doi: 10.4253/wjge.v14.i1.49
Feasibility of gastric endoscopic submucosal dissection in elderly patients aged ≥ 80 years
Yasuhiro Inokuchi, Ayaka Ishida, Kei Hayashi, Yoshihiro Kaneta, Hayato Watanabe, Kazuki Kano, Mitsuhiro Furuta, Kosuke Takahashi, Hirohito Fujikawa, Takanobu Yamada, Kouji Yamamoto, Nozomu Machida, Takashi Ogata, Takashi Oshima, Shin Maeda
Yasuhiro Inokuchi, Ayaka Ishida, Kei Hayashi, Yoshihiro Kaneta, Mitsuhiro Furuta, Nozomu Machida, Department of Gastroenterology, Kanagawa Cancer Center, Yokohama 241-8515, Kanagawa, Japan
Hayato Watanabe, Kazuki Kano, Kosuke Takahashi, Hirohito Fujikawa, Takanobu Yamada, Takashi Ogata, Takashi Oshima, Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Kanagawa, Japan
Kouji Yamamoto, Department of Biostatics, Yokohama City University School of Medicine., Yokohama 236-0004, Kanagawa, Japan
Shin Maeda, Department of Gastroenterology, Yokohama City University, Yokohama 236-0004, Kanagawa, Japan
Author contributions: Inokuchi Y and Maeda S designed the study; Inokuchi Y, Ishida A, Hayashi K, Kaneta Y were involved in collection of data; Inokuchi Y, Yamamoto K, and Furuta M were involved in the data analysis; Inokuchi Y, Ishida A, Hayashi K, Kaneta Y, Watanabe H, Kano K, Furuta M, Takahashi K, Fujikawa H, Yamada T, Yamamoto K, Machida N, Ogata T, Oshima T, and Maeda S were involved in data interpretation; Inokuchi Y wrote the manuscript; Ishida A, Hayashi K, Kaneta Y, Watanabe H, Kano K, Furuta M, Takahashi K, Fujikawa H, Yamada T, Yamamoto K, Machida N, Ogata T, Oshima T, and Maeda S edited the manuscript; all authors critically revised the report, commented on drafts of the manuscript, and approved the final report.
Institutional review board statement: This study has been approved by the research ethics committee of Kanagawa Cancer Center, which complies with International Guidelines for Ethical Review of Epidemiological Studies.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. According to "Ethical Guidelines for Medical and Health Research Involving Human Subjects" published by Japanese Ministry of Health, Labor and Welfare, opt-out is accepted for practical procedure to obtain informed consent from the recruited patients, in retrospective study without any invasion or newly investigated information after recruitment. For our study, we have put information concerning the study on Kanagawa Cancer Center HP, to give recruited patients a chance to refuse entry to the study.
Conflict-of-interest statement: The authors have declared no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yasuhiro Inokuchi, MD, PhD, Chief Doctor, Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama 241-8515, Kanagawa, Japan. inokuchiy@kcch.jp
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: June 13, 2021
Revised: June 16, 2021
Accepted: December 11, 2021
Article in press: December 11, 2021
Published online: January 16, 2022
Processing time: 260 Days and 21.2 Hours
ARTICLE HIGHLIGHTS
Research background

Endoscopic submucosal dissection (ESD) is increasingly performed in elderly patients with early gastric cancer (EGC).

Research motivation

Whether gastric ESD is safe and suitable for elderly patients, type of lesions which carry an increased risk of procedure-related complications, indicators of prognosis for elderly patients after ESD are unclear.

Research objectives

To investigate short-term and long-term outcomes of gastric ESD for elderly patients, and to determine the risk factors of procedure-related complications and the indicators of prognosis.

Research methods

This study included patients aged ≥ 80 years who underwent ESD for EGC in Kanagawa Cancer Center Hospital. These patients were studied retrospectively to evaluate short-term outcomes and survival of gastric ESD.

Research results

The en bloc dissection rate was as high as 97.1%, and the complication rates of bleeding, perforation and aspiration pneumonitis were as low as 3.4%, 1.1% and 0.6%, respectively, which were similar to the rates of ESD for nonelderly patients. A dissection incision > 40 mm, lesions associated with depressions, and lesions with ulcers were risk factors for bleeding, and location of the lesion in the upper third of the stomach was a risk factor for perforation (P < 0.05). The overall survival (OS) did not differ significantly between curative and noncurative ESD groups (P = 0.69). In patients without additional surgery, OS rate was significantly lower in patients with a high Charlson comorbidity index (CCI) ≥ 2 than in patients with a low CCI ≤ 1 (P < 0.001).

Research conclusions

Gastric ESD is feasible even in elderly patients aged ≥ 80 years. Meticulous preventive endoscopic hemostasis after resecting specimens > 40 mm, or lesions associated with depressions or ulcers is recommended. CCI is a prognostic indicator. Observation without additional surgery after noncurative ESD is reasonable, especially in elderly patients with CCI ≥ 2.

Research perspectives

As our institution is a hub hospital specializing in cancer treatment, relatively healthy patients without severe underlying diseases tend to visit the hospital. Therefore, a selection bias of target patients may have existed in our study. A multicenter prospective trial with a large number of patients is desirable to confirm the feasibility of gastric ESD in patients with various health problems, and the risk factors and the prognostic indicators related to each underlying disease.