Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: A propensity-matched analysis

Chan Hyuk Park, Hyuk Lee, Dong Wook Kim, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, WooJin Hyung, SangKil Lee, Yongchan Lee, Sung Hoon Noh

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Abstract

Background: 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). Objective: To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. Design: Retrospective study with propensity-matched analysis. Setting: University-affiliated tertiary-care hospital, Seoul, South Korea. Patients: A total of 518 patients 70 years of age or older with initial-onset EGC. Interventions: ESD and surgery. Main Outcome Measurements: Clinical outcomes, disease-free survival, and overall survival. Results: 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). Limitations: Nonrandomized, retrospective study. Conclusions: 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.

Original languageEnglish
Pages (from-to)599-609
Number of pages11
JournalGastrointestinal Endoscopy
Volume80
Issue number4
DOIs
Publication statusPublished - 2014 Oct 1

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Stomach Neoplasms
Safety
Survival
Length of Stay
Retrospective Studies
Endoscopic Mucosal Resection
Splenic Artery
Matched-Pair Analysis
Republic of Korea
Tertiary Healthcare
Tertiary Care Centers
Disease-Free Survival
Intensive Care Units
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Park, Chan Hyuk ; Lee, Hyuk ; Kim, Dong Wook ; Chung, Hyunsoo ; Park, Jun Chul ; Shin, Sung Kwan ; Hyung, WooJin ; Lee, SangKil ; Lee, Yongchan ; Noh, Sung Hoon. / Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer : A propensity-matched analysis. In: Gastrointestinal Endoscopy. 2014 ; Vol. 80, No. 4. pp. 599-609.
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abstract = "Background: 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). Objective: To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. Design: Retrospective study with propensity-matched analysis. Setting: University-affiliated tertiary-care hospital, Seoul, South Korea. Patients: A total of 518 patients 70 years of age or older with initial-onset EGC. Interventions: ESD and surgery. Main Outcome Measurements: Clinical outcomes, disease-free survival, and overall survival. Results: 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). Limitations: Nonrandomized, retrospective study. Conclusions: 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.",
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Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer : A propensity-matched analysis. / Park, Chan Hyuk; Lee, Hyuk; Kim, Dong Wook; Chung, Hyunsoo; Park, Jun Chul; Shin, Sung Kwan; Hyung, WooJin; Lee, SangKil; Lee, Yongchan; Noh, Sung Hoon.

In: Gastrointestinal Endoscopy, Vol. 80, No. 4, 01.10.2014, p. 599-609.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer

T2 - A propensity-matched analysis

AU - Park, Chan Hyuk

AU - Lee, Hyuk

AU - Kim, Dong Wook

AU - Chung, Hyunsoo

AU - Park, Jun Chul

AU - Shin, Sung Kwan

AU - Hyung, WooJin

AU - Lee, SangKil

AU - Lee, Yongchan

AU - Noh, Sung Hoon

PY - 2014/10/1

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N2 - Background: 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). Objective: To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. Design: Retrospective study with propensity-matched analysis. Setting: University-affiliated tertiary-care hospital, Seoul, South Korea. Patients: A total of 518 patients 70 years of age or older with initial-onset EGC. Interventions: ESD and surgery. Main Outcome Measurements: Clinical outcomes, disease-free survival, and overall survival. Results: 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). Limitations: Nonrandomized, retrospective study. Conclusions: 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.

AB - Background: 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). Objective: To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. Design: Retrospective study with propensity-matched analysis. Setting: University-affiliated tertiary-care hospital, Seoul, South Korea. Patients: A total of 518 patients 70 years of age or older with initial-onset EGC. Interventions: ESD and surgery. Main Outcome Measurements: Clinical outcomes, disease-free survival, and overall survival. Results: 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). Limitations: Nonrandomized, retrospective study. Conclusions: 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.

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