Abstract: Objective:To investigate the safety and efficacy of endoscopic submucosal dissection (ESD) in elderly patients (age≥65 years) with early gastric cancer.
Methods:The retrospective cohort study was adopted. The clinical data of 145 patients with early gastric cancer who underwent ESD at the Peking University Cancer Hospital between January 2011 and June 2014 were collected. Of 145 patients, 57 (age≥65 years) were allocated into the elderly group and 88 (age<65 years) were allocated into the nonelderly group. ESD was performed to all the patients after the multidisciplinary discussion and evaluation. Observation indicators included operation time, volume of intraoperative blood loss, duration of hospital stay, complications, integrity of resected specimens, negative resection margin, tumor cure and followup (survival, tumor recurrence and metastasis). The followup using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis till June 2015. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using t test. Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric U test. Count data were analyzed using the chisquare test.
Results:Operation time, volume of intraoperative blood loss, duration of hospital stay, numbers of patients with postoperative perforation, bleeding, en bloc resection of tumor, piecemeal resection of tumor, negative resection margins, positive resection margins, curative resection, extended curative resection and noncurative resection were 100 minutes (range, 20-470 minutes), 25 mL (range, 5-200 mL), 5 days (range, ²-10 days), 1, 2, 52, 5, 50, 7, 30, 17, 10 in the elderly group and 110 minutes (range, 25-480 minutes), 25 mL (range, 5-600 mL), 4 days (range, ²-29 days), 3, 3, 85, 3, 83, 5, 47, 24, 17 in the nonelderly group, respectively, with no significant differences between the 2 groups (U=2 451.000, 2 183.500, 2 116.500, χ²=1.544, 1.018, 1.210, 0.142, P>0.05). Patients with complications were improved after symptomatic treatment. Of 145 patients, 135 were followed up for a median time of 26 months (range, 1²- 53 months).  Tumor recurrence rates in the elderly and nonelderly groups were 1.8%(1/57)  and  2.3%(2/88), showing no significant difference between the 2 groups (χ²=0.000, P>0.05). No tumor recurrence and metastasis and death were occurred in other patients.
Conclusion:ESD is safe and feasible in the treatment of elderly patients with early gastric cancer, and it is equivalent to short and longterm efficacies of ESD in nonelderly patients.