Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2017; 9(10): 416-422
Published online Oct 15, 2017. doi: 10.4251/wjgo.v9.i10.416
Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer
Yoshihiro Otsuka, Kazuya Akahoshi, Kayoko Yasunaga, Masaru Kubokawa, Junya Gibo, Shigeki Osada, Kayo Tokumaru, Kazuaki Miyamoto, Takao Sato, Yuki Shiratsuchi, Masafumi Oya, Hidenobu Koga, Eikichi Ihara, Kazuhiko Nakamura
Yoshihiro Otsuka, Kazuya Akahoshi, Masaru Kubokawa, Junya Gibo, Shigeki Osada, Kayo Tokumaru, Kazuaki Miyamoto, Takao Sato, Yuki Shiratsuchi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Kayoko Yasunaga, Diagnosis Procedure Combination Coding Management Office, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Masafumi Oya, Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Hidenobu Koga, Clinical Research Supportive Office, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Eikichi Ihara, Kazuhiko Nakamura, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Author contributions: Otsuka Y and Akahoshi K contributed equally to this work; Yasunaga K, Shiratsuchi Y and Koga H collected and analyzed the data; Otsuka Y, Akahoshi K, Kubokawa M, Gibo J, Osada S, Tokumaru K, Miyamoto K, Sato T, Oya M, Ihara E and Nakamura K performed the research; Otsuka Y wrote the paper; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Iizuka Hospital.
Informed consent statement: The ethics committee of Aso Iizuka Hospital approved this study (registration No. 12120). Written informed consent was obtained from all patients.
Conflict-of-interest statement: Kazuya Akahoshi and Hidefumi Akahane (Fujifilm) have applied for a patent in Europe for the CC described in this article. Japan, China, and the United States have already granted patents.
Data sharing statement: Informed consent was not obtained for data sharing, and no additional data are available.
Open-Access: 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/
Correspondence to: Kazuya Akahoshi, MD, PhD, Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio, Iizuka 820-8505, Japan. kakahoshi2@aol.com
Telephone: +81-948-223800 Fax: +81-948-298747
Received: June 7, 2017
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
AIM
To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter (ESDCC) in older patients.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
