Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80\xa0years

Tomoyuki Nishimura,Shiro Oka,Kazuaki Chayama,Kenta Matsumoto,Katsuaki Inagaki,Hirosato Tamari,Yasutsugu Shimohara,Yasuhiko Kitadai,Hidenori Tanaka,Shinji Tanaka,Yuki Ninomiya,Yuki Kamigaichi,Yuki Okamoto,Ken Yamashita,Koji Arihiro

doi:10.1186/s12876-021-01899-y

Tomoyuki Nishimura, Shiro Oka + Show 13 more

Open Access

https://doi.org/10.1186/s12876-021-01899-y

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Abstract

BackgroundIn Japan, endoscopic submucosal dissection (ESD) is standardized for large colorectal tumors. However, its validity in the elderly population is unclear. We aimed to evaluate the safety and efficacy of ESD for colorectal tumors in elderly patients aged over 80 years.MethodsESD was performed on 178 tumors in 165 consecutive patients aged over 80 years between December 2008 and December 2018. We retrospectively evaluated the clinicopathological characteristics and clinical outcomes of ESD. We also assessed the prognosis of 160 patients followed up for more than 12 months.ResultsThe mean patient age was 83.7 ± 3.1 years. The number of patients with comorbidities was 100 (62.5%). Among all patients, 106 (64.2%) were categorized as class 1 or 2 according to the American Society of Anesthesiologists classification of physical status (ASA-PS), and 59 (35.8%) were classified as class 3. The mean procedure time was 97.7 ± 79.3 min. The rate of histological en bloc resection was 93.8% (167/178). Delayed bleeding in 11 cases (6.2%) and perforation in 7 cases (3.9%) were treated conservatively. The 5-year survival rate was 89.9%. No deaths from primary disease (mean follow-up time: 35.3 ± 27.5 months) were observed. Overall survival rates were significantly lower in the non-curative resection group that did not undergo additional surgery than in the curative resection group (P = 0.0152) and non-curative group that underwent additional surgery (P = 0.0259). Overall survival rates were higher for ASA-PS class 1 or 2 patients than class 3 patients (P = 0.0105). Metachronous tumors (> 5 mm) developed in 9.4% of patients.ConclusionsESD for colorectal tumors in patients aged over 80 years is safe. Colorectal cancer-associated deaths were prevented although comorbidities pose a high risk of poor prognosis.

Highlights

In Japan, endoscopic submucosal dissection (ESD) is standardized for large colorectal tumors
The main factor contributing to increased mortality of colorectal cancers in Japan is an increase in the morbidity of colorectal carcinomas in the elderly population [1, 2]
We evaluated the long-term prognosis of ESD for colorectal tumors in patients aged over 80 years with comorbidities

Summary

Introduction

In Japan, endoscopic submucosal dissection (ESD) is standardized for large colorectal tumors. Its validity in the elderly population is unclear. We aimed to evaluate the safety and efficacy of ESD for colorectal tumors in elderly patients aged over 80 years. The elderly population is growing rapidly worldwide, especially in developed countries, leading to increased life expectancy. People often have comorbidities that pose difficulties when performing surgeries that require general anesthesia for treatment. Improvements in healthcare technology have increased life expectancy, especially of the elderly population. The main factor contributing to increased mortality of colorectal cancers in Japan is an increase in the morbidity of colorectal carcinomas in the elderly population [1, 2]. Given that the general condition of elderly patients is inferior to that of younger patients, appropriate treatment options are necessary

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