The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

Simple Summary In this study, we elucidated whether endoscopic submucosal dissection for early gastric cancer is safe and feasible in very old patients. We compared the characteristics and outcomes of patients aged >= 85 years with those of other patients. We found no significant differences in the incidence of adverse events between patients >= 85 years of age and other patients. However, the overall survival of patients aged >= 85 years was significantly lower than that of other patients. We found that poor nutritional status was correlated with poor prognosis in patients aged >= 85 years. Therefore, we conclude that endoscopic submucosal dissection for early gastric cancer is safe and valid for patients aged >= 85 years. However, the indications should be carefully decided because it is difficult to estimate the survival benefits of endoscopic submucosal dissection for early gastric cancer in patients aged >= 85 years, especially those with poor nutritional status. Endoscopic submucosal dissection (ESD) is a safe and minimally invasive method for the treatment of early gastric cancer (EGC). However, whether ESD for EGC is also safe and feasible in patients aged >= 85 years is unclear. The patients enrolled in this study were divided into three groups: age >= 85 years (44 patients, 49 lesions), age 65-84 years (624 patients, 687 lesions), and age <= 64 years (162 patients, 174 lesions). We evaluated the incidence of adverse events (AEs) and overall survival (OS) and disease-specific survival (DSS). We analyzed the factors that had a significant impact on the prognosis of patients aged >= 85 years. No significant differences were found in the incidence of AEs among the three groups (p = 0.612). The OS was significantly lower in patients aged >= 85 years (p < 0.001). Conversely, DSS was not significantly worse in patients aged >= 85 years (p = 0.100). The poor Geriatric Nutritional Risk Index correlated with poor prognosis in patients aged >= 85 years (p < 0.001). ESD is a safe and valid treatment for EGC in patients aged >= 85 years. However, the indications should be carefully decided because it is difficult to estimate the survival contribution of ESD for EGC in patients aged >= 85 years, especially in those with poor nutritional status.