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Endoscopic Submucosal Dissection Enough to Cure Early Gastric Cancer?

Vanessa M. Shami, MD, FASGE reviewing Waki K, et al. Gastrointest Endosc 2021 Dec 31.

Over the past decade, with advances in endoscopic resection (ER) techniques, there has been a trend toward removing early gastric cancer (EGC) with ER, especially in older patients who may have an elevated risk of surgical adverse events. This single-center retrospective study aimed to examine outcomes and overall survival (OS) of patients aged 75 years or older who underwent ER for EGC. Additionally, the investigators determined factors to identify optimal patients for this technique.

The study enrolled 400 consecutive patients (with 472 lesions) aged 75 years or older (mean age, 79.3) who underwent ER for EGC from January 2007 to December 2012 at Osaka International Cancer Institute. ESD was used to resect 439 lesions, and EMR was utilized to remove 33. Data collected included the Eastern Cooperative Oncology Group performance status (ECOG-PS), Charlson Comorbidity Index, and Prognostic Nutritional Index (PNI). 

The 3- and 5-year OS rates were 89.6% (95% confidence interval [CI], 86.0%-92.2%) and 80.8% (95% CI, 76.4%-84.4%), respectively. The 5-year net survival, standardized for age, sex, and calendar year, was 1.09 (95% CI, 1.03-1.15). Independent prognostic factors associated with poor OS by multivariate analysis (hazard ratio; 95% CI) included age of 77 years or older (2.35; 1.16-4.74), ECOG-PS 2-4 (8.84; 3.07-25.4), PNI <49.1 (2.49; 1.53-4.06), and endoscopic curability C-2 (1.79; 1.11-2.88). When none of these factors were met, the 5-year OS rate was 90.4% (95% CI, 84.0%-94.30%). Adverse events included 11 perforations (2.8%; 10 managed endoscopically), 29 bleeds (7.3%; 28 managed endoscopically), and 4 cases of pneumonia.


Comment:

ER of EGC seems like a viable, safe, and less invasive treatment option in older patients, with a high 5-year OS. It is imperative to note that these data come from a high-volume therapeutic center with extensive ER experience. Patients with EGC undergoing ER should be assessed and managed at high-volume centers for best outcomes.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
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Vanessa M. Shami, MD, FASGE

Bio and Disclosures

Citation(s):

Waki K, Shichijo S, Uedo N, et al. Long-term outcomes after endoscopic resection for late elderly patients with early gastric cancer. Gastrointest Endosc 2021 Dec 31. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.12.028)
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