# Outcome and Prognostic Factors of Colorectal Endoscopic Submucosal Dissection in Patients Aged Over 75 Years

## TL;DR

This study shows that colorectal ESD is safe for elderly patients, but outcomes depend on health and nutrition factors.

## Contribution

The study identifies comorbidities and nutritional status as key factors affecting survival in elderly patients undergoing colorectal ESD.

## Key findings

- Elderly patients had significantly worse overall survival compared to nonelderly patients.
- Complication rates and curative resection outcomes were similar between elderly and nonelderly groups.
- High comorbidity index and low nutritional index were linked to poorer survival in elderly patients.

## Abstract

We aimed to evaluate the safety and efficacy, and prognostic factors of colorectal endoscopic submucosal dissection (ESD) in patients aged ≥ 75 years.

We retrospectively collected cases of colorectal ESD performed between January 2008 and December 2023. Patients were divided into two groups: elderly (≥ 75 years) and nonelderly (< 75 years). We compared clinicopathological characteristics, clinical outcomes, overall survival (OS), and disease‐specific survival (DSS) between the groups. We also analyzed factors associated with OS in the elderly group.

A total of 523 patients with 548 lesions were enrolled. Among them, 168 patients with 175 lesions were classified as elderly, and 355 patients with 373 lesions were in the nonelderly group. No significant differences were found in en bloc resection, curative resection, or complication rates between the two groups (p = 1.000, 0.703, and 0.583, respectively). The OS of the elderly group was significantly worse (p < 0.001), while DSS did not differ significantly (p = 0.155). A high Charlson comorbidity index and low prognostic nutritional index were associated with poorer OS in the elderly group.

Colorectal ESD is a safe and effective treatment for patients aged ≥ 75 years. Indication for colorectal ESD should be carefully determined based on comorbidities and nutritional status to improve outcomes in this population.