EUS-Based Endoscopic Resection in Elderly Patients with Early Gastric Cancer: A Single-Center Experience

內視鏡超音波協助下使用內視鏡切除術於老人早期胃癌之單一醫學中心經驗

范峻維(Guin-Wei Fan) ； 林淳榮(Chun-Jung Lin) ； 宋昌穆(Chang-Mung Sung) ； 陳聰興(Tsung-Hsing Chen) ； 許振銘(Cheng-Ming Hsu) ； 林偉彬(Wei-Pin Lin) ； 蘇銘堯(Ming-Yao Su) ； 陳澤卿(Tse-Ching Chen) ； 邱正堂(Cheng-Tang Chiu)

《臺灣消化醫學雜誌》 30卷1期 (2013/03) Pp. 1-10

https://doi.org/10.6557/GJT.201303_30(1).0001

摘要

Background and Aim: In recent decades, as endoscopic technique and instruments are improved, endoscopic resection techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), have all been accepted as effective and popular treatment choices in addition to surgical resection for early gastric cancer (EGC). Because of the advantages of lower invasiveness and organ preservation, it might be also assumed beneficial for elderly patients at high risk of postoperative complications and comorbidities and who have a limited life expectancy. This study was conducted to evaluate the efficacy and safety of endoscopic resection for the treatment of EGC in elderly patients based on the use of endoscopic ultrasound (EUS) selection in one medical center. Materials and Methods: From July 2000 to January 2011, elderly patients (those older than 65 years) who had undergone EMR or ESD for early gastric cancer were retrospectively analyzed. All the patients received pretreatment staging including computed tomography (CT) and EUS. The patients who had obvious muscularis propria invasion, perigastric lymph nodes, or distant metastasis were all excluded. The demographic characteristics, comorbidities, endoscopic morphological features and resection methods, complications, clinical outcomes, and survival time on follow-up were all recorded. Results: A total of 35 elderly patients (median age, 72 years; range, 65-90 years) received endoscopic resection for EGC. The major comorbidities included hypertension (54.3%), diabetes mellitus (22.9%), and coronary artery disease (20%). ESD was performed in 18 patients (ESD group), and EMR was performed in 17 patients (EMR group). The ESD group required longer procedure times than the EMR group (174 minutes vs. 24.6 minutes, P ＜ 0.001). For tumors ＜ 20 mm, the en block rate in the ESD group versus the EMR group was 41% (5/12) versus 53% (8/15; P = 0.261), respectively. For tumors ＞ 20 mm, the en block rate in the ESD group versus the EMR group was 66.67% (4/6) versus 50% (1/2; P = 0.135), respectively. The delayed bleeding rates in the ESD and EMR groups were 15.7% and 4% (P = 0.833), respectively. Only 1 patient in the ESD group had a perforation. There was 1 local recurrence in each group of patients during the follow-up. No disease-related mortality was observed. There was no survival difference between the groups. Conclusion: In our study, endoscopic resections (either ESD or EMR) had comparable complete resection rates and clinical outcomes for elderly patients with EGC. It may be beneficial as an alternative choice for patients with comorbidities and high surgical risk. EUS is a useful modality for patients with EMR/ESD for preprocedure staging and evaluation of retreatment of local recurrence.

關鍵字

早期胃癌 ； 內視鏡黏膜切除術 ； 老人 ； 內視鏡超音波檢查

並列摘要

Background and Aim: In recent decades, as endoscopic technique and instruments are improved, endoscopic resection techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), have all been accepted as effective and popular treatment choices in addition to surgical resection for early gastric cancer (EGC). Because of the advantages of lower invasiveness and organ preservation, it might be also assumed beneficial for elderly patients at high risk of postoperative complications and comorbidities and who have a limited life expectancy. This study was conducted to evaluate the efficacy and safety of endoscopic resection for the treatment of EGC in elderly patients based on the use of endoscopic ultrasound (EUS) selection in one medical center. Materials and Methods: From July 2000 to January 2011, elderly patients (those older than 65 years) who had undergone EMR or ESD for early gastric cancer were retrospectively analyzed. All the patients received pretreatment staging including computed tomography (CT) and EUS. The patients who had obvious muscularis propria invasion, perigastric lymph nodes, or distant metastasis were all excluded. The demographic characteristics, comorbidities, endoscopic morphological features and resection methods, complications, clinical outcomes, and survival time on follow-up were all recorded. Results: A total of 35 elderly patients (median age, 72 years; range, 65-90 years) received endoscopic resection for EGC. The major comorbidities included hypertension (54.3%), diabetes mellitus (22.9%), and coronary artery disease (20%). ESD was performed in 18 patients (ESD group), and EMR was performed in 17 patients (EMR group). The ESD group required longer procedure times than the EMR group (174 minutes vs. 24.6 minutes, P ＜ 0.001). For tumors ＜ 20 mm, the en block rate in the ESD group versus the EMR group was 41% (5/12) versus 53% (8/15; P = 0.261), respectively. For tumors ＞ 20 mm, the en block rate in the ESD group versus the EMR group was 66.67% (4/6) versus 50% (1/2; P = 0.135), respectively. The delayed bleeding rates in the ESD and EMR groups were 15.7% and 4% (P = 0.833), respectively. Only 1 patient in the ESD group had a perforation. There was 1 local recurrence in each group of patients during the follow-up. No disease-related mortality was observed. There was no survival difference between the groups. Conclusion: In our study, endoscopic resections (either ESD or EMR) had comparable complete resection rates and clinical outcomes for elderly patients with EGC. It may be beneficial as an alternative choice for patients with comorbidities and high surgical risk. EUS is a useful modality for patients with EMR/ESD for preprocedure staging and evaluation of retreatment of local recurrence.

並列關鍵字

early gastric cancer ； endoscopic mucosal resection ； elderly ； endoscopic ultrasonography