Long-term prognosis after endoscopic submucosal dissection for esophageal cancer in older adult patients

Autor: Hirona Konishi, Yuji Urabe, Takeo Nakamura, Kazuki Ishibashi, Junichi Mizuno, Motomitsu Fukuhara, Takeshi Takasago, Hidenori Tanaka, Akiyoshi Tsuboi, Ken Yamashita, Yuichi Hiyama, Hidehiko Takigawa, Takahiro Kotachi, Ryo Yuge, Akira Ishikawa, Shiro Oka
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: BMC Gastroenterology, Vol 24, Iss 1, Pp 1-9 (2024)
Druh dokumentu: article
ISSN: 1471-230X
DOI: 10.1186/s12876-024-03234-7
Popis: Abstract Background The validity of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) in older individuals with comorbidities remains unclear. Therefore, this study evaluated the safety and efficacy of ESD and additional treatment for ESCC in older adult patients. Methods The clinicopathological characteristics and clinical outcomes of 398 consecutive older adult patients (≥ 65 years) with 505 lesions who underwent ESD for ESCC at the Hiroshima University Hospital between September 2007 and December 2019 were retrospectively evaluated. Additionally, the prognoses of 381 patients who were followed up for > 3 years were assessed. Results The mean patient age and procedure time were 73.1 ± 5.8 years and 77.1 ± 43.5 min, respectively. The histological en bloc resection rate was 98% (496/505). Postoperative stenosis, perforation, pneumonia, and delayed bleeding were conservatively treated in 82 (16%), 19 (4%), 15 (3%), and 5 (1%) patients, respectively. The 5-year overall and disease-specific survival rates were 78.9% and 98.0%, respectively (mean follow-up time: 71.1 ± 37.3 months). Multivariate analysis showed that age and the American Society of Anesthesiologists classification of physical status class ≥III (hazard ratio: 1.27; 95% confidence interval: 1.01–1.59, p = 0.0392) were independently associated with overall survival. A significantly lower overall survival rate was observed in the high-risk follow-up group than in the low-risk follow-up and high-risk additional treatment groups (p
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