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Surgery Today
Published in: Surgery Today 9/2022

28-01-2022 | Gastrectomy | Original Article

Prognosis after curative resection for stage IA gastric cancer in elderly patients: endoscopic submucosal dissection versus surgery

Authors: Koji Miyahara, Michihiro Ishida, Yoshiyasu Kono, Tetsu Hirata, Yuka Obayashi, Tatsuhiro Gotoda, Yuki Ninomiya, Yuki Moritou, Masaki Kunihiro, Tetsushi Kubota, Yasuhiro Choda, Yasuhiro Shirakawa, Masahiro Nakagawa, Hiroyuki Okada

Published in: Surgery Today | Issue 9/2022

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Abstract

Purpose

To establish whether gastrectomy for early gastric cancer (EGC) in elderly patients is related to poor survival.

Methods

The subjects of this retrospective study were patients aged ≥ 75 years with primary stage IA EGC, who underwent curative resection with endoscopic submucosal dissection (ESD) or surgery.

Results

We analyzed data on 365 patients who underwent ESD and 170 patients who underwent surgery. Overall survival (OS) was not significantly different for the ESD group vs. the surgery group (5-year cumulative rates, 81.5% vs. 79.7%; log-rank test, P = 0.506). Multivariate analysis revealed that treatments; namely, ESD or surgery, were not associated with OS (hazard ratio 1.09, 95% confidence interval 0.77–1.51). Similar results were observed even in the subgroups with worse conditions, such as age > 80 years, Eastern Cooperative Oncology Group performance status 2–3, Charlson comorbidity index ≥ 2, and prognostic nutritional index ≤ 46.7. Using propensity score matching, we selected 88 pairs of patients who underwent ESD or surgery with baseline characteristics matched and found that OS was not different between the two groups (log-rank test, P = 0.829).

Conclusion

OS was comparable for elderly patients who underwent ESD and those who underwent surgery for EGC. Surgical invasiveness did not worsen the prognosis, even for elderly patients.
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Metadata
Title
Prognosis after curative resection for stage IA gastric cancer in elderly patients: endoscopic submucosal dissection versus surgery
Authors
Koji Miyahara
Michihiro Ishida
Yoshiyasu Kono
Tetsu Hirata
Yuka Obayashi
Tatsuhiro Gotoda
Yuki Ninomiya
Yuki Moritou
Masaki Kunihiro
Tetsushi Kubota
Yasuhiro Choda
Yasuhiro Shirakawa
Masahiro Nakagawa
Hiroyuki Okada
Publication date
28-01-2022
Publisher
Springer Nature Singapore
Published in
Surgery Today / Issue 9/2022
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-022-02456-0

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