Usefulness of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in elderly patients: a single-center retrospective cohort study.

Abstract

The effectiveness of endoscopic treatment for superficial esophageal squamous cell carcinoma in the elderly is unclear. We retrospectively studied efficacy and safety of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in 358 patients at our hospital from July 2005 to December 2018. Patients were divided into elderly (≥75years) and young (≤74years) groups. Efficacy was evaluated based on overall survival and disease-specific survival, whereas safety was investigated based on the frequency of endoscopic submucosal dissection-related adverse events. The median observation period was 50months. The elderly group comprised 111 patients, and young group comprised 247 patients. In the elderly and young groups, 76 (68.5%) and 159 (64.4%) underwent curative resection (P=0.450), 8 (7.2%) and 34 (13.8%) underwent non-curative resection plus additional treatment and 12 (10.8%) and 15 (6.0%) underwent follow-up, respectively. The frequency of additional treatment for non-curative resection was significantly lower in the elderly group (P=0.023). The 3-year overall survival of the elderly and young groups was 85.6 and 94.1%, respectively (P=0.003). The 3-year disease-specific survival of the elderly and young groups was 98.4 and 98.5% (P=0.682), respectively. The frequency of endoscopic submucosal dissection-related adverse events did not differ significantly between the groups (P=0.581). The Charlson Comorbidity Index ≥2 was an independent prognostic factor for survival in the elderly group (P=0.010; hazard ratio, 5.570; 95% confidence interval, 1.519-20.421). Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in elderly patients is as safe as that for young patients. The evaluation of Charlson Comorbidity Index was considered to help estimate the prognosis of elderly patients.