比较内镜黏膜下剥离术和手术治疗不适合内镜切除的老年早期胃癌。
Comparison of endoscopic submucosal dissection and surgery for early gastric cancer that is not indicated for endoscopic resection in elderly patients.
机构信息
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Korea.
Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
出版信息
Surg Endosc. 2023 Jun;37(6):4766-4773. doi: 10.1007/s00464-023-09989-6. Epub 2023 Mar 13.
BACKGROUND
Endoscopic submucosal dissection (ESD) is sometimes performed for early gastric cancer (EGC) which is not indicated for endoscopic resection (ER) in elderly patients considering old age and comorbidities. We aimed to compare outcomes between ESD and surgery in elderly patients with EGC that is not indicated for ER.
METHODS
Elderly patients aged ≥ 75 years who underwent either ESD or surgery for EGC which was not indicated for ER between 2005 and 2015 were retrospectively investigated.
RESULTS
Among a total of 294 patients, 59 (20.1%) and 235 (79.9%) patients underwent ESD and surgery as the initial treatment, respectively. The ESD group had smaller size of tumors (25 vs. 30 mm, p = .001) and higher rate of differentiated-type cancer than the surgery group had (88.1% vs. 60.9%, p = 0.001). With a median observation period of 91.8 months (range 11.6-198.1 months), 141 (48.0%) patients died: 25 (42.4%) and 116 (49.4%) patients in the ESD group and the surgery group, respectively. Overall survival and disease-free survival between the two groups had no significant differences (p = 0.982. p = 0.155, respectively).
CONCLUSIONS
ESD may be an alternative option for EGC which is not indicated for ER in elderly patients aged ≥ 75 years, considering old age and comorbidity.
背景
对于考虑到年龄和合并症而不适合内镜下切除（ER）的老年患者，内镜黏膜下剥离术（ESD）有时用于治疗早期胃癌（EGC）。我们旨在比较 EGC 不适合 ER 的老年患者中 ESD 与手术的治疗结果。
方法
回顾性分析了 2005 年至 2015 年间年龄≥75 岁且因 EGC 不适合 ER 而行 ESD 或手术治疗的老年患者。
结果
共 294 例患者中，59 例（20.1%）和 235 例（79.9%）患者分别接受 ESD 和手术作为初始治疗。ESD 组肿瘤直径较小（25 与 30mm，p=0.001），且分化型癌比例高于手术组（88.1%与 60.9%，p=0.001）。中位观察时间为 91.8 个月（范围 11.6-198.1 个月），141 例（48.0%）患者死亡：ESD 组和手术组分别有 25 例（42.4%）和 116 例（49.4%）患者死亡。两组患者的总生存和无病生存无显著差异（p=0.982，p=0.155）。
结论
对于年龄≥75 岁且因年龄和合并症而不适合 ER 的 EGC 患者，ESD 可能是一种替代治疗选择。
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