Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis.

BACKGROUND

Little is known about the clinical and oncologic outcomes of endoscopic submucosal dissection (ESD) compared with surgery in elderly patients with early gastric cancer (EGC).

OBJECTIVE

To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication.

DESIGN

Retrospective study with propensity-matched analysis.

SETTING

University-affiliated tertiary-care hospital, Seoul, South Korea.

PATIENTS

A total of 518 patients 70 years of age or older with initial-onset EGC.

INTERVENTIONS

ESD and surgery.

MAIN OUTCOME MEASUREMENTS

Clinical outcomes, disease-free survival, and overall survival.

RESULTS

In a propensity-matched analysis of 132 pairs, the length of hospital stay of the ESD group was shorter than that of the surgery group (median [interquartile range], 4 [3-4] vs 9 [7-11] days; P < .001). Intensive care unit admission occurred in the surgery group only (7 patients [5.3%]). Two surgery-related deaths occurred in the surgery group (1 splenic artery bleeding and 1 anastomosis site leakage). During follow-up, metachronous lesions developed more often in the ESD group than in the surgery group (12 vs 2 lesions, P = .004). All recurred lesions were successfully treated endoscopically except for 3 patients who refused additional treatment. Overall survival did not differ between the 2 groups (P = .280).

LIMITATIONS

Nonrandomized, retrospective study.

CONCLUSIONS

ESD is a safe procedure in elderly patients with EGC. Although the risk of metachronous lesions is higher in patients who undergo ESD than in those who undergo surgery, overall survival did not differ between the patients who undergo ESD and surgery.