Journal Article Endoscopic Submucosal Dissection is Feasible for Very Elderly Patients with Early Gastric Cancer : Comparison of Short-Term and Long-Term Outcomes in Very Elderly and Non-Elderly Patients
超高齢者における内視鏡的粘膜下層剥離術は早期胃癌に適した治療である : 非高齢者との短期成績と長期成績の比較による検討

Komori, Keishi  ,  Nakamura, Kazuhiko  ,  Ihara, Eikichi  ,  Iwasa, Tsutomu  ,  Hirahashi, Minako  ,  Oda, Yoshinao  ,  Takayanagi, Ryoichi

107 ( 4 )  , pp.72 - 81 , 2016-04-25 , Fukuoka Medical Association
Background/Aims : Endoscopic submucosal dissection (ESD) has become a standard procedure for the resection of early gastric cancer (EGC). However, the feasibility of ESD for very elderly patients, aged ≥ 80 years, has not been determined. Methodology : The study population included 67 non-elderly (NE) patients aged ≤ 65 years (80 lesions) and 22 very elderly (VE) patients ≥ 80 years (26 lesions) with EGC who underwent ESD and met the criteria for absolute or expanded indications. Eighteen patients (18 lesions) who underwent ESD but did not meet the criteria for absolute and expanded indications were defined as the outside the indications (OI) group. Results : En bloc and complete resection rates were excellent in both the VE and NE groups, without differing significantly. Although the rates of ischemic heart disease and antithrombotic agent use were higher in the VE than in the NE group, procedure-related complication rates did not differ significantly. Of the seven very elderly patients in the OI group, two underwent additional gastrectomy, and the other five were followed-up without surgery. No patient in any group experienced local recurrence, metastasis or disease-specific death. Conclusions : Short- and long-term outcomes of ESD for VE patients with EGC were favorable and did not differ significantly from outcomes in NE patients. ESD may therefore be a good therapeutic option for both VE and NE patients with EGC.
【背景】内視鏡的粘膜下層剥離術は早期胃癌治療のスタンダードとなっている.しかしながら,80歳以上の超高齢者に適した治療であるかはいまだ明らかではない.【方法】ガイドライン絶対適応内病変と適応拡大病変と診断した89 名の患者106 症例を65 歳以下のNE群,80 歳以上のVE 群とし両群の比較検討を行った.ガイドラインを満たさない18 症例は適応外病変と定義した.【結果】一括完全切除率はVEとNE両群で良好であり,統計学的有意差は認めなかった.NE 群と比較してVE 群に虚血性心疾患の併存症と抗血栓薬の使用が多かったが,内視鏡的粘膜下層剥離術における合併症に有意差は認めなかった.適応外病変の患者18 症例のうち7 症例が超高齢者であり,うち2 名が追加外科切除をうけ,残る5 名は経過観察とした.すべての群で局所再発,遠隔転移,胃癌関連死は認めなかった.【結論】早期胃癌に対する内視鏡的粘膜下層剥離術の短期及び長期成績は超高齢者において非高齢者と同様に良好であった.

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