Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years
Abstract Background In 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. Methods ESD...
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-021-01899-y |
| _version_ | 1818661628456992768 |
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| author | Tomoyuki Nishimura Shiro Oka Shinji Tanaka Yuki Kamigaichi Hirosato Tamari Yasutsugu Shimohara Yuki Okamoto Katsuaki Inagaki Kenta Matsumoto Hidenori Tanaka Ken Yamashita Yuki Ninomiya Yasuhiko Kitadai Koji Arihiro Kazuaki Chayama |
| author_facet | Tomoyuki Nishimura Shiro Oka Shinji Tanaka Yuki Kamigaichi Hirosato Tamari Yasutsugu Shimohara Yuki Okamoto Katsuaki Inagaki Kenta Matsumoto Hidenori Tanaka Ken Yamashita Yuki Ninomiya Yasuhiko Kitadai Koji Arihiro Kazuaki Chayama |
| author_sort | Tomoyuki Nishimura |
| collection | DOAJ |
| description | Abstract Background In 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. Methods ESD 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. Results The 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. Conclusions ESD 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. |
| first_indexed | 2024-12-17T04:48:05Z |
| format | Article |
| id | doaj.art-e1a04307e3384c27a30bf2472ff43694 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-17T04:48:05Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-e1a04307e3384c27a30bf2472ff436942022-12-21T22:03:01ZengBMCBMC Gastroenterology1471-230X2021-08-012111910.1186/s12876-021-01899-yLong-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 yearsTomoyuki Nishimura0Shiro Oka1Shinji Tanaka2Yuki Kamigaichi3Hirosato Tamari4Yasutsugu Shimohara5Yuki Okamoto6Katsuaki Inagaki7Kenta Matsumoto8Hidenori Tanaka9Ken Yamashita10Yuki Ninomiya11Yasuhiko Kitadai12Koji Arihiro13Kazuaki Chayama14Department of Gastroenterology and Metabolism, Hiroshima University HospitalDepartment of Gastroenterology and Metabolism, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of Endoscopy, Hiroshima University HospitalDepartment of the Faculty of Human Culture and Science, Prefectural University of HiroshimaDepartment of Anatomical Pathology, Hiroshima University HospitalDepartment of Gastroenterology and Metabolism, Hiroshima University HospitalAbstract Background In 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. Methods ESD 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. Results The 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. Conclusions ESD 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.https://doi.org/10.1186/s12876-021-01899-yColorectal tumorElderlyEndoscopic submucosal dissection (ESD)Colorectal cancerThe American Society of Anesthesiologists classification of physical status (ASA-PS) classLong-term prognosis |
| spellingShingle | Tomoyuki Nishimura Shiro Oka Shinji Tanaka Yuki Kamigaichi Hirosato Tamari Yasutsugu Shimohara Yuki Okamoto Katsuaki Inagaki Kenta Matsumoto Hidenori Tanaka Ken Yamashita Yuki Ninomiya Yasuhiko Kitadai Koji Arihiro Kazuaki Chayama Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years BMC Gastroenterology Colorectal tumor Elderly Endoscopic submucosal dissection (ESD) Colorectal cancer The American Society of Anesthesiologists classification of physical status (ASA-PS) class Long-term prognosis |
| title | Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years |
| title_full | Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years |
| title_fullStr | Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years |
| title_full_unstemmed | Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years |
| title_short | Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years |
| title_sort | long term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years |
| topic | Colorectal tumor Elderly Endoscopic submucosal dissection (ESD) Colorectal cancer The American Society of Anesthesiologists classification of physical status (ASA-PS) class Long-term prognosis |
| url | https://doi.org/10.1186/s12876-021-01899-y |
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