Published online Oct 15, 2017. doi: 10.4251/wjgo.v9.i10.416
Peer-review started: June 12, 2017
First decision: July 11, 2017
Revised: July 24, 2017
Accepted: August 2, 2017
Article in press: August 4, 2017
Published online: October 15, 2017
To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter (ESDCC) in older patients.
We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients (> 80 years, n = 64) and non-older patients (≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status (PS) before and after ESDCC, and financial cost of admission.
The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease (P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients (100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications (i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization (11.4 and 10.7 d, respectively) and financial cost of admission (657040 JPY and 574890 JPY, respectively).
ESDCC has a good clinical outcome in older patients.
Core tip: No previous reports have described the clinical outcomes of endoscopic submucosal dissection using the Clutch Cutter (ESDCC) for older patients with early gastric cancer (EGC). The present study evaluated the clinical outcomes, including medical economics, associated with ESDCC for older patients. There was no significant difference between older patients and non-older patients in the rate of ESDCC-related complications. There was also no significant difference between older and non-older patients in the mean duration of hospitalization and medical economics. We conclude that ESDCC is safe and effective for older and non-older patients with EGC.