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Surgical Endoscopy

Published in:

01-10-2017

Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma

Authors: Byeong Geun Song, Yang Won Min, Jun Haeng Lee, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee, Jae J. Kim

Published in: Surgical Endoscopy | Issue 10/2017

Abstract

Background

Endoscopic submucosal dissection (ESD) has been widely applied in superficial esophageal squamous cell carcinoma (SESCC) as a minimally invasive treatment, which has advantages over surgery, especially in the elderly who have high risk of surgery. This study elucidated the efficacy and safety of ESD for SESCC in the elderly.

Methods

Between April 2007 and June 2016, a total of 176 patients with SESCC treated with ESD were analyzed. Clinical outcomes including En bloc, complete, and curative resection rates, procedure-related complication rates, and cumulative recurrence rates were compared between the elderly (n = 46, ≥70 years of age) and the non-elderly groups (n = 130, <70 years of age).

Results

Between the two groups, sex, past medical history (hypertension and diabetes), body mass index, tumor characteristics (number, location, shape, maximal and circumferential size of the tumor and the resected specimen, and depth), and use of stricture prevention except for age (elderly vs non-elderly; 74.1 ± 2.78 vs. 61.1 ± 6.06 years, p < 0.001) did not differ. En bloc resection (elderly vs. non-elderly; 93.5 vs. 93.8%, p = 1.000), complete resection (elderly vs. non-elderly; 69.6 vs. 76.2%, p = 0.433), and curative resection rates (elderly vs. non-elderly; 54.3 vs. 60.0%, p = 0.602) did not differ significantly between the two groups. Procedure time and hospital stay were also similar between the two groups. Complications of ESD such as stricture (17.4 vs. 10.8%, p = 0.299) and perforation (13.0 vs. 6.2%, p = 0.083) occurred at a similar rate in the elderly and non-elderly groups. After curative ESD, cumulative recurrence rate of the elderly group (0%) did not differ significantly to that of the non-elderly group (5.1%) by the log-rank test (p = 0.307).

Conclusion

ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.

Zhang Y (2013) Epidemiology of esophageal cancer. World J Gastroenterol 19:5598–5606CrossRefPubMedPubMedCentral

Mocanu A, Barla R, Hoara P, Constantinoiu S (2015) Current endoscopic methods of radical therapy in early esophageal cancer. J Med Life 8:150–156PubMedPubMedCentral

Sakai M, Kuwano H (2016) [Endoscopic therapy for esophageal cancer]. Kyobu Geka 69:718–723PubMed

Choi LJ, Lee NR, Kim SG, Lee WS, Park SJ, Kim JJ, Lee JH, Kwon JW, Park SH, You JH, Kim JH, Lim CH, Cho JY, Kim GH, Lee YC, Jung HY, Kim JY, Chun HJ, Seol SY (2016) Short-term outcomes of endoscopic submucosal dissection in patients with early gastric cancer: A prospective multicenter cohort study. Gut Liver 10:739–748CrossRefPubMedPubMedCentral

Min BH, Kim ER, Kim KM, Park CK, Lee JH, Rhee PL, Kim JJ (2015) Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer. Endoscopy 47:784–793CrossRefPubMed

Pyo JH, Lee H, Min BH, Lee JH, Choi MG, Lee JH, Sohn TS, Bae JM, Kim KM, Ahn JH, Carriere KC, Kim JJ, Kim S (2016) Long-term outcome of endoscopic resection vs. surgery for early gastric cancer: a non-inferiority-matched cohort study. Am J Gastroenterol 111:240–249CrossRefPubMed

Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, Shikuwa S (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22:311–317CrossRefPubMed

Kato M, Michida T, Kusakabe A, Sakai A, Hibino C, Kato M, Tokuda Y, Kawai T, Hamano M, Chiba M, Maeda K, Yamamoto K, Naito M, Ito T (2016) Safety and short-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients. Endosc Int Open 4:E521–526CrossRefPubMedPubMedCentral

Toyokawa T, Fujita I, Morikawa T, Okamoto A, Miyasaka R, Watanabe K, Horii J, Gobaru M, Terao M, Murakami T, Tomoda J (2011) Clinical outcomes of ESD for early gastric neoplasms in elderly patients. Eur J Clin Invest 41:474–478CrossRefPubMed

10.

Kim JS, Kim BW, Shin IS (2014) Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci 59:1862–1869CrossRefPubMed

11.

Park JS, Youn YH, Park JJ, Kim JH, Park H (2016) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc 49:168–175CrossRefPubMedPubMedCentral

12.

Pech O, May A, Gossner L, Rabenstein T, Manner H, Huijsmans J, Vieth M, Stolte M, Berres M, Ell C (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39:30–35CrossRefPubMed

13.

Probst A, Aust D, Markl B, Anthuber M, Messmann H (2015) Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 47:113–121PubMed

14.

Repici A, Hassan C, Carlino A, Pagano N, Zullo A, Rando G, Strangio G, Romeo F, Nicita R, Rosati R, Malesci A (2010) Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 71:715–721CrossRefPubMed

15.

Sun F, Yuan P, Chen T, Hu J (2014) Efficacy and complication of endoscopic submucosal dissection for superficial esophageal carcinoma: a systematic review and meta-analysis. J Cardiothorac Surg 9:78–87CrossRefPubMedPubMedCentral

16.

Tsujii Y, Nishida T, Nishiyama O, Yamamoto K, Kawai N, Yamaguchi S, Yamada T, Yoshio T, Kitamura S, Nakamura T, Nishihara A, Ogiyama H, Nakahara M, Komori M, Kato M, Hayashi Y, Shinzaki S, Iijima H, Michida T, Tsujii M, Takehara T (2015) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 47:775–783CrossRefPubMed

17.

Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, D’Amico TA (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78:1170–1176CrossRefPubMed

18.

Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coebergh JW, Weeks JC, Earle CC (2006) Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 24:4277–4284CrossRefPubMed

19.

Kikuchi O, Mouri H, Matsueda K, Yamamoto H (2012) Endoscopic submucosal dissection for treatment of patients aged 75 years and over with esophageal cancer. ISRN Gastroenterol 2012:671324CrossRefPubMedPubMedCentral

20.

Peng C, Shen S, Xu G, Lv Y, Zhang X, Ling T, Wang L, Ding X, Zou X (2016) Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms. United Eur Gastroenterol J 4:242–249CrossRef

21.

Iizuka T, Kikuchi D, Yamada A, Hoteya S, Kajiyama Y, Kaise M (2015) Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy 47:341–344PubMed

22.

Kataoka M, Anzai S, Shirasaki T, Ikemiyagi H, Fujii T, Mabuchi K, Suzuki S, Yoshida M, Kawai T, Kitajima M (2015) Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer. Endosc Int Open 3:E113–117PubMed

23.

Wang W, Ma Z (2015) Steroid administration is effective to prevent strictures after endoscopic esophageal submucosal dissection: a network meta-analysis. Medicine (Baltimore) 94:e1664CrossRef

24.

Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol 17:1721–1724CrossRefPubMed

25.

Endoscopic Classification Review Group (2005) Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578CrossRef

Title: Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma
Authors: Byeong Geun Song
Yang Won Min
Jun Haeng Lee
Hyuk Lee
Byung-Hoon Min
Poong-Lyul Rhee
Jae J. Kim
Publication date: 01-10-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5421-4

2024 ASCO Annual Meeting

Springer Medicine

Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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