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- Title
Additive treatment improves survival in elderly patients after non-curative endoscopic resection for early gastric cancer.
- Authors
Jung, Da Hyun; Lee, Yong; Kim, Jie-Hyun; Lee, Sang; Shin, Sung; Park, Jun; Chung, Hyunsoo; Park, Jae; Youn, Young; Park, Hyojin; Lee, Yong Chan; Lee, Sang Kil; Shin, Sung Kwan; Park, Jun Chul; Park, Jae Jun; Youn, Young Hoon
- Abstract
<bold>Background and Study Aims: </bold>Endoscopic resection (ER) is accepted as a curative treatment option for selected cases of early gastric cancer (EGC). Although additional surgery is often recommended for patients who have undergone non-curative ER, clinicians are cautious when managing elderly patients with GC because of comorbid conditions. The aim of the study was to investigate clinical outcomes in elderly patients following non-curative ER with and without additive treatment.<bold>Patients and Methods: </bold>Subjects included 365 patients (>75 years old) who were diagnosed with EGC and underwent ER between 2007 and 2015. Clinical outcomes of three patient groups [curative ER (n = 246), non-curative ER with additive treatment (n = 37), non-curative ER without additive treatment (n = 82)] were compared.<bold>Results: </bold>Among the patients who underwent non-curative ER with additive treatment, 28 received surgery, three received a repeat ER, and six experienced argon plasma coagulation. Patients who underwent non-curative ER alone were significantly older than those who underwent additive treatment. Overall 5-year survival rates in the curative ER, non-curative ER with treatment, and non-curative ER without treatment groups were 84, 86, and 69 %, respectively. No significant difference in overall survival was found between patients in the curative ER and non-curative ER with additive treatment groups. The non-curative ER groups were categorized by lymph node metastasis risk factors to create a high-risk group that exhibited positive lymphovascular invasion or deep submucosal invasion greater than SM2 and a low-risk group without risk factors. Overall 5-year survival rate was lowest (60 %) in the high-risk group with non-curative ER and no additive treatment.<bold>Conclusions: </bold>Elderly patients who underwent non-curative ER with additive treatment showed better survival outcome than those without treatment. Therefore, especially with LVI or deep submucosal invasion, additive treatment is recommended in patients undergoing non-curative ER, even if they are older than 75 years.
- Subjects
SOUTH Korea; ENDOSCOPIC surgery; ENDOSCOPY; STOMACH cancer treatment; ONCOLOGIC surgery; DISEASES in older people; ELECTROCOAGULATION (Medicine); CANCER invasiveness; GASTROSCOPY; REOPERATION; STOMACH tumors; SURVIVAL; COMORBIDITY; RETROSPECTIVE studies; EARLY detection of cancer
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2017, Vol 31, Issue 3, p1376
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-016-5123-3