Xu WS, Zhang HY, Jin S, Zhang Q, Liu HD, Wang MT, Zhang B. Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients. World J Gastrointest Surg 2024; 16(2): 511-517 [PMID: 38463378 DOI: 10.4240/wjgs.v16.i2.511]
Corresponding Author of This Article
Hui-Yu Zhang, MSc, Doctor, Department of Gastroenterology, The Third Affiliated Hospital of Qiqihar Medical University, No. 27 Taishun Street, Tiefeng District, Qiqihar 161099, Heilongjiang Province, China. 32397208@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wen-Si Xu, Hui-Yu Zhang, Shuang Jin, Qi Zhang, Hong-Dan Liu, Ming-Tao Wang, Bo Zhang, Department of Gastroenterology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar 161099, Heilongjiang Province, China
Author contributions: Xu WS and Zhang HY designed the study; Jin S, Zhang Q, Liu HD, Wang MT and Zhang B contributed to the data collection and analysis; Xu WS drafted the manuscript; All authors have read and approved the final manuscript.
Supported byQiqihar Scientific and Technological Plan Joint Guidance Projects, No. LSFGG-2023015.
Institutional review board statement: The study was reviewed and approved by The Third Affiliated Hospital of Qiqihar Medical University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report having no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Yu Zhang, MSc, Doctor, Department of Gastroenterology, The Third Affiliated Hospital of Qiqihar Medical University, No. 27 Taishun Street, Tiefeng District, Qiqihar 161099, Heilongjiang Province, China. 32397208@qq.com
Received: December 5, 2023 Peer-review started: December 5, 2023 First decision: December 21, 2023 Revised: January 5, 2024 Accepted: January 17, 2024 Article in press: January 17, 2024 Published online: February 27, 2024
Abstract
BACKGROUND
With advancements in the development of endoscopic technologies, the endoscopic submucosal dissection (ESD) has been one of the gold-standard therapies for early gastric cancer.
AIM
To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.
METHODS
Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were selected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022. Among them, 39 patients treated with ESD were included in an experimental group, and 39 patients treated with endoscopic mucosal resection (EMR) were included in a control group. We compared the basic intraoperative conditions, postoperative short-term recovery, long-term recovery effects and functional status of gastric mucosa between the two groups; the basic intraoperative conditions included lesion resection, intraoperative bleeding and operation time; the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complications; and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoperatively; and we compared the preoperative and predischarge serum pepsinogen I (PG I) and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.
RESULTS
The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group. The intraoperative bleeding volume was higher in the experimental group than in the control group. The operation time was longer in the experimental group than that in the control group, and the rate for base residual focus was lower in the experimental group than that of the control group, and the differences were all statistically significant (all P < 0.05). The length of hospital stay was longer in the experimental group than in the control group, and the incidence of surgical complications, 1-year postoperative recurrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group, and the differences were statistically significant (all P < 0.05). However, the difference in the 1-year postoperative survival rate was not statistically significant between the two groups (P > 0.05). Before discharge, PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period, and the above indexes were higher in the experimental group than those in the control group, and the differences were statistically significant (both P < 0.05). Moreover, before discharge, PG II level was lower in both groups compared with the preoperative period, and the level was lower in the experimental group than in the control group, and the differences were all statistically significant (all P < 0.05).
CONCLUSION
Compared with EMR, ESD surgery is more thorough. It reduces the rate of base residual focus, recurrence rate, surgical complications, and promotes the recovery of gastric cells and glandular function. It is safe and suitable for clinical application.
Core Tip: Endoscopic submucosal dissection is one of the most commonly used minimally invasive therapies for early gastric cancer and precancerous lesions. The present study compared the primary intraoperative conditions, postoperative short- and long-term recovery and functional status of gastric mucosa between elderly patients undergoing endoscopic submucosal dissection vs those undergoing endoscopic mucosal resection to evaluate the efficacy and safety of these two operations.
