Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:63-9. doi: 10.1111/j.1440-1746.2012.07075.x.
Endoscopic submucosal dissection (ESD) is reported to be a safe and reliable procedure for the elderly, but these reports could have already had a bias at the time ESD was performed. However, the reports have not clearly stated the criteria of indications. In the present study, we retrospectively elucidated the usefulness and problems of ESD for early gastric cancer in elderly patients (≥ 65 years) in comparison with non-elderly patients.
The subjects were selected from 412 consecutive patients with early gastric cancer (515 lesions) for which ESD was performed between June 2002 and February 2010. The following were used for analysis between groups: pre- and postoperative performance status (PS) of subjects, prevalence rates of pre-existing comorbidities, characteristics of lesions, treatment outcomes, durations of hospitalization, operating times, incidence rates of complications and durations of hospitalization, and postoperative hemorrhage rates, and duration of hospitalization in patients with anticoagulant therapy.
Of the lesions in the elderly, four patients (1.0%) were elderly with a PS of 3. The PS increased to six patients (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. The ratio of patients with a pre-existing comorbidity was higher in the elderly than in the non-elderly. There were no differences between the two groups in the characteristics of the lesions, their duration of hospitalization, their operating times, or the incidence rates of complications. However, the elderly with perforations had a significantly longer hospitalization than the comparable non-elderly. The percentage of the patients taking anticoagulant drugs was significantly higher among the elderly. Of the patients on anticoagulant therapy, the duration of hospitalization tended to be longer in the elderly but no significant difference was found. None of the non-elderly with postoperative hemorrhage had received anticoagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were in those who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group.
We conclude that ESD is useful in elderly patients because there is a similar risk as for the non-elderly if the approach is individualized, and the following are taken into consideration when making the final decision of performing ESD in an elderly patient: patients should have a PS of 0, 1, or 2; determine whether or not anticoagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.
内镜黏膜下剥离术（ESD）被报道为一种安全可靠的治疗老年人疾病的方法，但这些报道在进行 ESD 时可能已经存在偏见。然而，这些报道并没有明确说明适应证的标准。在本研究中，我们通过回顾性分析，比较了老年（≥65 岁）和非老年患者行 ESD 治疗早期胃癌的有效性和问题。
我们从 2002 年 6 月至 2010 年 2 月期间连续对 412 例早期胃癌（515 处病灶）患者行 ESD 治疗，从中选择研究对象。对两组患者进行分组分析：术前和术后患者的表现状态（PS）、并存疾病的患病率、病变特征、治疗效果、住院时间、手术时间、并发症发生率和住院时间、以及抗凝治疗患者的术后出血率和住院时间。
在老年患者的病变中，有 4 例（1.0%）为 PS3 的老年患者。术后 PS3 的患者增加至 6 例（1.6%）。术前和术后均无非老年患者 PS3。老年患者的并存疾病患病率高于非老年患者。两组患者病变特征、住院时间、手术时间或并发症发生率均无差异。然而，穿孔的老年患者住院时间明显长于可比的非老年患者。服用抗凝药物的老年患者比例明显高于非老年患者。接受抗凝治疗的患者中，老年患者的住院时间趋于延长，但无显著差异。非老年患者中无术后出血患者接受抗凝治疗。在老年患者的术后出血中，有 15.8%的病变患者接受了抗凝治疗，表明老年组中此类病变的比例明显更高。
我们认为，如果个体化治疗，ESD 对老年患者是有用的，因为与非老年患者的风险相似，在决定对老年患者行 ESD 治疗时应考虑以下因素：患者 PS 应为 0、1 或 2；确定是否可以停用抗凝药物以及是否可以可靠地进行治疗而无并发症。
