Background and study aims: Data on survival for elderly Western patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are scarce.
Patients and methods: A multicenter, prospective, cohort study (2016-2022) was conducted in 26 Spanish hospitals that included patients aged > 70 years treated with ESD for EGC. The primary endpoint was overall survival in octogenarians compared with the previous decade; secondary outcomes included safety and technical success.
Results: A total of 217 patients were included, 135 in their 70s (Group A) and 82 in their 80s (Group B). Group B had higher comorbidity (73.2% vs 46.7%; P < 0.001) and greater anticoagulant use (39.5% vs 17.3%; P < 0.001). Technical success and intraprocedural adverse events were similar, but delayed bleeding was higher in Group B (22.8% vs 8.2%; P = 0.003). No intraprocedural deaths occurred, but three patients in Group B (3.6%) died within 30 days (2 post-ESD, 1 post-surgery). Of 169 patients followed (77.9%), 28 died (16%), including two cancer-related deaths in Group B. Five-year overall survival (OS) was 78% in Group A and 57% in Group B ( P = 0.03); median survival in Group B was 58.5 months. Multivariate analysis identified American Society of Anesthesiologists performance status (ASA-PS) ≥ III as the only independent risk factor for lower OS (hazard ratio 3.9; 95% confidence interval 1.3-11.3; P = 0.014).
Conclusions: Octogenarians with EGC benefit from ESD in a Western setting in terms of disease-free survival, but have lower long-term survival due to comorbidities, underscoring the importance of pre-procedure risk assessment. ESD is a proven safe technique, but in the subgroup of patients aged ≥ 80 years with severe comorbidities (ASA-PS ≥ IV), periprocedural mortality is increased and the indication should be carefully evaluated.
Keywords: Endoscopic resection (ESD, EMRc, ...); Endoscopy Upper GI Tract; Performance and complications; Precancerous conditions & cancerous lesions (displasia and cancer) stomach; Quality and logistical aspects.
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).