The Effectiveness And Safety Of Endoscopic Submucosal Dissection For Early Esophageal Squamous Neoplasm In The Elderly

Background: Endoscopic submucosal dissection (ESD) can be used as a minimally invasive treatment in the early stages of esophageal squamous cell carcinoma (ESCC). Due to the higher frequency of under-lying illnesses, the superiority of ESD to esophagectomy is more prominent in the elderly than in the non-elderly. This study compared the efficacy and safety of ESD for early ESCC between the elderly and non-elderly patients.Methods: from August 2014 to December 2019, 59 patients treated with ESD for early ESCC were retro-spectively analyzed. The elderly group (n = 20) comprised patients aged >= 65 years, and the non-elderly group (n = 39) comprised those aged < 65 years. Clinical and pathological results, including R0 resection, curative resection, survival, and complication rates were compared between the groups.Result: Both groups were male predominant (elderly: 80%, non-elderly: 87.2%), and the tumor was mostly found in the mid thoracic (elderly: 40%, non-elderly: 61.5%). Tumor size, depth of tumor, and lymphovascular invasion were not significantly different between the groups. Tumor occupying >= 3/4 circumference of the esophagus was only found in the non-elderly group (elderly: 0, non-elderly: 8; p = 0.036). The RO resection rate (elderly: 100%, non-elderly: 94.9%, p = 0.544), curative resection rate (elderly: 80%, non-elderly: 79.5%, p = 1), recurrence rate (elderly: 10%, non-elderly: 10.3%, p = 1), follow-up period (elderly: 20.4 +/- 16.8 months, non-elderly: 21 +/- 17.6 months, p = 0.904), and post ESD stricture (elderly: 5%, non-elderly: 7.7%, p = 1) were similar between the two groups. The elderly had longer hospital stays than the non-elderly, but without a significant difference (elderly: 5 +/- 1.4 days, non-elderly: 4.3 +/- 1.3 days; p = 0.08). Post ESD stricture was correlated with the tumor circumference (p = 0.001). Cox model stratified by age groups, adjusting for other factors, non-curative ESD and concur-rent other malignancy were associated with increased 5.5-year mortality (hazard ratio 6.30; 95% CI, 1.03-38.68; hazard ratio 13.78; 95% Cl, 1.50-126.48).Conclusion: ESD was effective and safe for early ESCC in the elderly. Copyright (C) 2020, Taiwan Society of Geriatric Emergency & Critical Care Medicine.