Park Chan Hyuk, Lee Hyuk, Kim Dong Wook, Chung Hyunsoo, Park Jun Chul, Shin Sung Kwan, Hyung Woo Jin, Lee Sang Kil, Lee Yong Chan, Noh Sung Hoon
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Gastrointest Endosc. 2014 Oct;80(4):599-609. doi: 10.1016/j.gie.2014.04.042. Epub 2014 Jun 25.
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).
To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication.
Retrospective study with propensity-matched analysis.
University-affiliated tertiary-care hospital, Seoul, South Korea.
A total of 518 patients 70 years of age or older with initial-onset EGC.
ESD and surgery.
Clinical outcomes, disease-free survival, and overall survival.
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).
Nonrandomized, retrospective study.
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.
与手术治疗相比，内镜黏膜下剥离术（ESD）治疗老年早期胃癌（EGC）患者的临床和肿瘤学结局鲜为人知。
评估ESD与手术治疗相比，在扩大适应证的老年EGC患者中的临床和肿瘤学结局。
倾向匹配分析的回顾性研究。
韩国首尔的大学附属三级医院。
共有518例70岁及以上初发EGC患者。
ESD和手术。
临床结局、无病生存期和总生存期。
在132对倾向匹配分析中，ESD组的住院时间短于手术组（中位数[四分位间距]，4[3 - 4]天对9[7 - 11]天；P <.001）。仅手术组有患者入住重症监护病房（7例患者[5.3%]）。手术组发生2例与手术相关的死亡（1例脾动脉出血和1例吻合口漏）。随访期间，ESD组异时性病变的发生频率高于手术组（12处对2处病变，P =.004）。除3例拒绝进一步治疗的患者外，所有复发病变均通过内镜成功治疗。两组的总生存期无差异（P =.280）。
非随机、回顾性研究。
ESD对于老年EGC患者是一种安全的手术。虽然接受ESD的患者发生异时性病变的风险高于接受手术的患者，但接受ESD和手术的患者的总生存期并无差异。
