Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma.

Abstract

Endoscopic submucosal dissection (ESD) has been widely applied in superficial esophageal squamous cell carcinoma (SESCC) as a minimally invasive treatment, which has advantages over surgery, especially in the elderly who have high risk of surgery. This study elucidated the efficacy and safety of ESD for SESCC in the elderly. Between April 2007 and June 2016, a total of 176 patients with SESCC treated with ESD were analyzed. Clinical outcomes including En bloc, complete, and curative resection rates, procedure-related complication rates, and cumulative recurrence rates were compared between the elderly (n = 46, ≥70years of age) and the non-elderly groups (n = 130, <70years of age). Between the two groups, sex, past medical history (hypertension and diabetes), body mass index, tumor characteristics (number, location, shape, maximal and circumferential size of the tumor and the resected specimen, and depth), and use of stricture prevention except for age (elderly vs non-elderly; 74.1 ± 2.78 vs. 61.1 ± 6.06years, p < 0.001) did not differ. En bloc resection (elderly vs. non-elderly; 93.5 vs. 93.8%, p = 1.000), complete resection (elderly vs. non-elderly; 69.6 vs. 76.2%, p = 0.433), and curative resection rates (elderly vs. non-elderly; 54.3 vs. 60.0%, p = 0.602) did not differ significantly between the two groups. Procedure time and hospital stay were also similar between the two groups. Complications of ESD such as stricture (17.4 vs. 10.8%, p = 0.299) and perforation (13.0 vs. 6.2%, p = 0.083) occurred at a similar rate in the elderly and non-elderly groups. After curative ESD, cumulative recurrence rate of the elderly group (0%) did not differ significantly to that of the non-elderly group (5.1%) by the log-rank test (p = 0.307). ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.