Safety and usefulness of endoscopic submucosal dissection for early esophageal cancers in elderly patients aged 80 years or older

Background and aim Endoscopic submucosal dissection (ESD) for early gastrointestinal (GI) cancers is widely performed as a standard treatment in Japan. Given the increasing life expectancy worldwide, it is naturally regarded that the rate of elderly patients diagnosed with early GI cancer has increased. Available guidelines do not specifically outline how to manage endoscopic therapy for the elderly. The aim of this study was to assess the safety and usefulness of ESD for superficial esophageal squamous cell carcinoma (SESCC) in elderly patients. Methods We retrospectively investigated 393 consecutive patients, who underwent 426 ESD for 444 SESCCs from January 2011 to August 2016 at our institution. For this study, patients were divided into 2 groups based on their age; ≥ 80 years (Group aged ≥ 80 years, n = 42) and < 80 years (group aged < 80 years, n = 351). Patient demographics, sedation methods, technical outcomes, adverse events, sedatives, dosages given, overall survival, and disease-specific survival were then examined. Results The ESD procedure time was significantly longer for group aged ≥ 80 years than for group aged < 80 years (110 min [range 29–260] vs 85 min [24–504], p = 0.006); however, there was no significant differences between other technical items and adverse events. The 3-year overall survival and disease-specific survival were favorable in both groups. Conclusions Esophageal ESD for elderly patients aged ≥ 80 years can be safely performed. Mid-term outcome was favorable. Our study suggests that esophageal ESD might be a useful treatment for SESCCs.