Zhang Yan, Huang Lijiang, Li Lin, Ji Feng
1 Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China .
J Laparoendosc Adv Surg Tech A. 2014 Jun;24(6):391-8. doi: 10.1089/lap.2013.0572.
To retrospectively evaluate the safety and feasibility of endoscopic submucosal dissection (ESD) for the treatment of early gastric cancer (EGC) in elderly patients ≥75 years of age.
One hundred seventy-one patients (187 lesions) treated with ESD from January 2010 to September 2013 were enrolled in our study. Subjects were classified into two groups: elderly (age ≥75 years) or non-elderly (age <75 years). Clinicopathological characteristics, resectability, curability, complications, rates of local recurrence, and residual disease were evaluated. Association of clinicopathological characteristics of the lesions with immediate bleeding was analyzed.
No significant differences in clinical characteristics were observed. The incidences of comorbidity were significantly different between the elderly group and the non-elderly group (P<.001). Of the elderly patients, 54.3% had two or more underlying diseases compared with 18.4% of the non-elderly patients (P<.001). Of the 98.0% of elderly patients and 97.1% of younger patients who received en bloc resection, curative resection reached 94.1% and 96.3%, respectively. Immediate bleeding occurred in 15.2% of the elderly group and 4.8% of the non-elderly group (P=.044). Operation time differed significantly (P=.039). No apparent discrepancy was observed in perforation and delayed bleeding. The differences in the invasion depth were considered between the two groups (P=.001). Logistic regression analysis revealed that the rate of immediate bleeding was associated with invasion depth (P=.003). There were no differences in the follow-up period and rates of local recurrence and residual disease.
ESD is safe and feasible for elderly patients in the era of a graying population. Higher risk of immediate bleeding and longer operation time should be concerned.
回顾性评估内镜黏膜下剥离术（ESD）治疗年龄≥75岁老年早期胃癌（EGC）的安全性和可行性。
纳入2010年1月至2013年9月接受ESD治疗的171例患者（187个病灶）。将受试者分为两组：老年组（年龄≥75岁）和非老年组（年龄<75岁）。评估临床病理特征、可切除性、治愈性、并发症、局部复发率和残留疾病情况。分析病灶的临床病理特征与即时出血的相关性。
未观察到临床特征的显著差异。老年组和非老年组合并症的发生率有显著差异（P<0.001）。老年患者中，54.3%有两种或更多基础疾病，而非老年患者为18.4%（P<0.001）。在接受整块切除的患者中，老年患者占98.0%，年轻患者占97.1%，治愈性切除分别达到94.1%和96.3%。老年组即时出血发生率为15.2%，非老年组为4.8%（P=0.044）。手术时间有显著差异（P=0.039）。穿孔和延迟出血方面未观察到明显差异。两组间侵袭深度存在差异（P=0.001）。Logistic回归分析显示，即时出血率与侵袭深度相关（P=0.003）。随访期以及局部复发率和残留疾病率无差异。
在人口老龄化时代，ESD对老年患者是安全可行的。应关注即时出血风险较高和手术时间较长的问题。
