# Endoscopic submucosal dissection for early gastric cancer in the elderly: Spanish multicenter prospective study during initial experience

## TL;DR

This study shows that endoscopic submucosal dissection (ESD) is a safe and effective treatment for early gastric cancer in elderly patients, though survival rates are lower in those over 80 due to comorbidities.

## Contribution

The study provides new survival data for elderly Western patients undergoing ESD for early gastric cancer, highlighting risks and outcomes specific to octogenarians.

## Key findings

- Five-year overall survival was 78% in patients in their 70s and 57% in those in their 80s.
- ASA-PS ≥ III was the only independent risk factor for lower overall survival in octogenarians.
- Delayed bleeding and 30-day mortality were higher in patients aged 80 and older.

## Abstract

Data on survival for elderly Western patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are scarce.

A multicenter, prospective, cohort study (2016–2022) was conducted in 26 Spanish hospitals that included patients aged > 70 years treated with ESD for EGC. The primary endpoint was overall survival in octogenarians compared with the previous decade; secondary outcomes included safety and technical success.

A total of 217 patients were included, 135 in their 70s (Group A) and 82 in their 80s (Group B). Group B had higher comorbidity (73.2% vs 46.7%;
P
< 0.001) and greater anticoagulant use (39.5% vs 17.3%;
P
< 0.001). Technical success and intraprocedural adverse events were similar, but delayed bleeding was higher in Group B (22.8% vs 8.2%;
P
= 0.003). No intraprocedural deaths occurred, but three patients in Group B (3.6%) died within 30 days (2 post-ESD, 1 post-surgery). Of 169 patients followed (77.9%), 28 died (16%), including two cancer-related deaths in Group B. Five-year overall survival (OS) was 78% in Group A and 57% in Group B (
P
= 0.03); median survival in Group B was 58.5 months. Multivariate analysis identified American Society of Anesthesiologists performance status (ASA-PS) ≥ III as the only independent risk factor for lower OS (hazard ratio 3.9; 95% confidence interval 1.3–11.3;
P
= 0.014).

Octogenarians with EGC benefit from ESD in a Western setting in terms of disease-free survival, but have lower long-term survival due to comorbidities, underscoring the importance of pre-procedure risk assessment. ESD is a proven safe technique, but in the subgroup of patients aged ≥ 80 years with severe comorbidities (ASA-PS ≥ IV), periprocedural mortality is increased and the indication should be carefully evaluated.