Endoscopy 2024; 56(S 02): S71-S72
DOI: 10.1055/s-0044-1782841
Abstracts | ESGE Days 2024
Oral presentation
Navigating Upper GI ESD: From biopsy to scar 26/04/2024, 10:00 – 11:00 Room 8

ESD for the treatment of early gastric cancer in the elderly: overall survival, safety, and technical success

M. Moreno-Sanchez
1   University Hospital October 12, Madrid, Spain
,
A. Herreros De Tejada
2   Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain
,
G. Fernandez-Esparrach
3   Hospital Clínic de Barcelona, Barcelona, Spain
,
U. Goikoetxea
4   Donostia University Hospital, Donostia, Spain
,
E. Rodriguez De Santiago
5   Ramón y Cajal Hospital, Madrid, Spain
,
E. Albéniz
6   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain
,
J. Rodríguez Sánchez
1   University Hospital October 12, Madrid, Spain
,
P. Miranda
7   Hospital de La Princesa, Madrid, Spain
,
O. Nogales Rincón
8   Gregorio Marañón General University Hospital, Madrid, Spain
,
H. Uchima
9   Germans Trias i Pujol Hospital, Badalona, Spain
,
Á. Terán
10   Marqués de Valdecilla University Hospital, Santander, Spain
,
J. C. Marín-Gabriel
1   University Hospital October 12, Madrid, Spain
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Aims Early gastric cancer (EGC) is increasingly common in elderly patients [1]. This study aimed to determine the overall survival (OS) in elderly patients with EGC (aged≥80 years) undergoing ESD and compare it with the previous decade's cohort (aged 70-79 years). Additionally, technical success and safety were analyzed.

Methods Prospective, multicenter, cohort study of all EGC treated by ESD in patients over 70 years across 26 hospitals in Spain from January 2016 to December 2022. OS was calculated using Kaplan-Meier analysis. Results were compared using log-rank test. Cox regression was used for multivariate analysis. Univariate analysis was performed using Student's t-test or Mann-Whitney test and Chi-square test or Fisher’s exact.

Results 217 patients were included, 135 (62.2%) aged 70-79 years (group A) and 82 (37.8%) aged≥80 years (group B). Patients in group B had more comorbidities, reflected in a higher anesthesic risk by the ASA-PS Classification System III or higher of 46.7% vs 73.2% (p<0.001), and higher use of anticoagulation therapy: 17.3% vs 39.5% (p<0.001). There were no differences in technical success, R0 rates were 75.8% and 78.5% (p=0.65) and curative rates were 71.8% and 67.9% (p=0.560), respectively. No differences were found in intraprocedural complications, but there was a higher rate of delayed bleeding in group B (8.2% vs 22.8%, p=0.003). Indications for surgery after ESD were: i) ESD complications: 1 patient in group B (1.2%) (p=0.416), ii) aborted ESD: 3 in group A (2.2%) and 2 in group B (2.4%) (p=1), iii) non-curative ESD: 23 in group A (17%) and 15 in group B (18.3%) (p=0.788). No deaths were reported during the procedure. Two patients (0.92%) died in the 30 days following ESD, both in group B (p=0.14). 139 patients (64%) were followed-up and 22 (15.6%) died during that time (none of these deaths was related to gastric cancer). The 3-year survival rate in group A was 90% and 5-year survival rate was 78%; in group B the 3-year survival rate was 64% and 5-year survival rate was 28% (median survival in group B: 58 months, CI 95% 29.51-87.52) (p<0.001). Most deaths (91%) occurred in patients with comorbidities (identified as an ASA PS≥III), 6 (27.3%) in group A and 14 (63.6%) in group B (p=0.007). Multivariate analysis showed that independent risk factors for lower OS were age≥80 years (HR 2.91; 95% IC, 1.20-7.05; p=0.018) and ASA PS≥III (HR 6.28; 95% IC, 1.43-27.53; p=0.015).

Conclusions ESD is a safe and feasible procedure in elderly patients with EGC in a Western context [2] [3] [4] [5] [6] [7]. Knowing that EGC may progress to advanced disease and death in 4-5 years without treatment [8], the presence and severity of comorbidities may guide the decision on whether to perform ESD.



Publication History

Article published online:
15 April 2024

© 2024. European Society of Gastrointestinal Endoscopy. All rights reserved.

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