Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Esophagus. 2021 Jan;18(1):81-89. doi: 10.1007/s10388-020-00750-9. Epub 2020 May 29.
Endoscopic submucosal dissection (ESD) for early gastrointestinal (GI) cancers is widely performed as a standard treatment in Japan. Given the increasing life expectancy worldwide, it is naturally regarded that the rate of elderly patients diagnosed with early GI cancer has increased. Available guidelines do not specifically outline how to manage endoscopic therapy for the elderly. The aim of this study was to assess the safety and usefulness of ESD for superficial esophageal squamous cell carcinoma (SESCC) in elderly patients.
We retrospectively investigated 393 consecutive patients, who underwent 426 ESD for 444 SESCCs from January 2011 to August 2016 at our institution. For this study, patients were divided into 2 groups based on their age; ≥ 80 years (Group aged ≥ 80 years, n = 42) and < 80 years (group aged < 80 years, n = 351). Patient demographics, sedation methods, technical outcomes, adverse events, sedatives, dosages given, overall survival, and disease-specific survival were then examined.
The ESD procedure time was significantly longer for group aged ≥ 80 years than for group aged < 80 years (110 min [range 29-260] vs 85 min [24-504], p = 0.006); however, there was no significant differences between other technical items and adverse events. The 3-year overall survival and disease-specific survival were favorable in both groups.
Esophageal ESD for elderly patients aged ≥ 80 years can be safely performed. Mid-term outcome was favorable. Our study suggests that esophageal ESD might be a useful treatment for SESCCs.
内镜黏膜下剥离术（ESD）已广泛应用于治疗日本早期胃肠道（GI）癌症，并作为一种标准治疗方法。鉴于全球预期寿命的延长，自然认为诊断为早期 GI 癌的老年患者的比例有所增加。现有的指南并没有特别详细说明如何管理老年患者的内镜治疗。本研究旨在评估 ESD 治疗老年人早期食管鳞状细胞癌（SESCC）的安全性和有效性。
我们回顾性调查了 2011 年 1 月至 2016 年 8 月在我院接受 426 例 SESCC 的 393 例连续患者，共进行了 444 例 ESD。在这项研究中，根据患者年龄将其分为 2 组：≥80 岁（组年龄≥80 岁，n=42）和<80 岁（组年龄<80 岁，n=351）。然后检查患者的人口统计学、镇静方法、技术结果、不良事件、镇静剂、给予剂量、总生存率和疾病特异性生存率。
组年龄≥80 岁的 ESD 手术时间明显长于组年龄<80 岁（110min [29-260] 与 85min [24-504]，p=0.006）；然而，其他技术项目和不良事件之间没有显著差异。两组的 3 年总生存率和疾病特异性生存率均良好。
对于年龄≥80 岁的老年患者，进行食管 ESD 是安全的。中期结果是有利的。我们的研究表明，食管 ESD 可能是 SESCC 的一种有用的治疗方法。
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