Long-term Outcomes of Endoscopic Submucosal Dissection Versus Surgery in Late Older Adult Patients Aged ≥75 Years With Early Gastric Cancer Meeting the Curative Resection Criteria.

purposeWe compared the long-term outcomes of endoscopic submucosal dissection (ESD) with those of surgery in late older adult patients aged ≥75 years with early gastric cancer (EGC) who met the curative resection criteria. MATERIALS AND

methodsThis multicenter retrospective study included 4,241 older adults with EGC who were treated with either ESD (n=4,083) or surgery (n=158) at 22 hospitals between 2010 and 2020. Overall survival (OS) and gastric cancer (GC) recurrence were investigated in the overall cohort and a 4-to-1 propensity score (PS)-matched cohort.

resultsDuring a median follow-up of 6.6 years, the 5-year OS rates were 84.8% and 82.9% in the ESD and surgery groups, respectively, and OS did not differ between the 2 groups in the overall (P=0.396) and PS-matched cohorts (P=0.248). In the PS-matched cohort, the multivariate analyses showed that overall mortality after ESD (adjusted hazard ratio, 0.77; 95% confidence interval, 0.57-1.04) did not increase compared to that after surgery. The GC recurrence rate after ESD was higher than that after surgery (6.1% [248/4,083] vs. 0.6% [1/158]; 5-year rate: 9.3% vs. 0.7%, respectively; P<0.001 for the overall and PS-matched cohorts). However, approximately 77% (190/248) of the recurrences in the ESD group were metachronous, most of which were successfully managed with endoscopic treatment. The ESD group had fewer adverse events (AEs, 7.6% vs. 12.0%; P=0.044) than the surgery group, and no ESD treatment-related deaths were observed.

conclusionsIn late older adult patients (aged ≥75 years) with EGC, long-term outcomes after ESD were comparable to those after surgery for EGC meeting the curative resection criteria, with acceptable treatment-related AEs.