Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Int J Colorectal Dis. 2012 Nov;27(11):1493-9. doi: 10.1007/s00384-012-1514-7. Epub 2012 Jun 7.
Endoscopic submucosal dissection (ESD) has recently been applied to treatment of colorectal neoplasia; however, its safety and efficacy in terms of follow-up outcomes in elders have not been thoroughly examined. The aim of this study is to describe the clinical outcomes of colorectal ESD in elderly patients.
Two groups of patients, elderly (≥ 75 years of age) and non-elderly (< 75 years of age), who underwent colorectal ESD at the National Cancer Center Hospital from February 1998 to December 2010 were retrospectively compared on the following measures: tumor size, procedure time, complication rates, en bloc resection rates, and curative resection rates. We also investigated the follow-up outcomes in non-curative resection cases.
Of 614 consecutive patients treated by colorectal ESD, 125 (20.4 %) comprised the elderly group, and 489 patients (79.6 %) comprised the non-elderly group. No significant differences were observed between the two groups in terms of tumor size, procedure time, complication rates, en bloc resection rates, and curative resection rates. Of the patients who underwent non-curative resection, 7/19 (36.8 %) and 47/63 (74.6 %) in the elderly and non-elderly group, respectively, underwent additional treatment. Among the elderly patients who were followed up without additional treatment, no case of local recurrence, residual lesions, or distant metastases was observed during the observation period.
Treatment outcomes of colorectal ESD were equivalent in both groups. However, many of the non-curative cases in the elderly patients were followed up without additional treatment. Future studies should focus on the outcome in such patients to confirm the feasibility of colorectal ESD in elderly patients.
内镜黏膜下剥离术（ESD）最近已应用于结直肠肿瘤的治疗；然而，其在老年患者随访结果方面的安全性和有效性尚未得到充分研究。本研究旨在描述老年患者结直肠 ESD 的临床结果。
回顾性比较了 1998 年 2 月至 2010 年 12 月在国家癌症中心医院接受结直肠 ESD 的两组患者，即老年（≥75 岁）组和非老年（<75 岁）组，比较了肿瘤大小、手术时间、并发症发生率、整块切除率和根治性切除率。我们还调查了非根治性切除病例的随访结果。
在 614 例连续接受结直肠 ESD 治疗的患者中，125 例（20.4%）为老年组，489 例（79.6%）为非老年组。两组患者在肿瘤大小、手术时间、并发症发生率、整块切除率和根治性切除率方面无显著差异。在非根治性切除的患者中，老年组的 7/19（36.8%）和非老年组的 47/63（74.6%）分别进行了额外治疗。在未接受额外治疗的老年患者中，在观察期间未发现局部复发、残留病变或远处转移。
两组患者的结直肠 ESD 治疗结果相当。然而，老年患者中的许多非根治性病例未接受额外治疗。未来的研究应集中在这些患者的结果上，以确认老年患者行结直肠 ESD 的可行性。
