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Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age

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Abstract

Background

Endoscopic submucosal dissection (ESD) has been used recently for successful en bloc resection of even large lesions, although no consensus appears in medical literature concerning its application to elderly patients. This prospective cohort study aimed to evaluate the efficacy and safety of colorectal ESD for patients 80 years of age or older.

Methods

Colorectal ESD procedure findings were compared with clinical outcomes, including associated complications and mortalities, for two age groups totaling 196 consecutive patients with 202 colorectal lesions. Of the 196 patients, 31 patients (16%) were 80 years of age or older (group E), and 165 patients (84%) were younger than 80 years (group Y).

Results

The median ages were 82 years in group E and 68 years in group Y. The frequency of chronic concomitant diseases was significantly higher in group E (65%) than in group Y (27%) (p = 0.003). No significant pressure decrease or need for oxygenation was observed in either group. In addition, groups E and Y did not differ significantly in terms of mean lesion sizes (40.9 vs. 39.7 mm) en bloc resection rates (84% vs. 93%), curative rates (78% vs. 84%), median procedure times (65 vs. 70 min), or associated complications (no perforation or delayed bleeding cases [0%] vs. 5 perforations [3%]) The median postprocedure hospitalization period was 3 days in both groups. Except for 10 cases requiring subsequent lymph node dissection surgery, follow-up colonoscopy examinations showed no recurrences or ESD-related mortalities in either group.

Conclusion

Colorectal ESD is a safe and effective treatment for elderly patients (age ≥ 80 years) despite a significantly higher frequency of chronic concomitant diseases than among younger patients.

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Disclosures

Toshio Uraoka, Reiji Higashi, Jun Kato, Eisuke Kaji, Hideyuki Suzuki, Shin Ishikawa, Mitsuhiro Akita, Tomoko Hirakawa, Shunsuke Saito, Keisuke Hori, Yoshiro Kawahara, Robert J. Mead, and Kazuhide Yamamoto have no conflicts of interest or financial ties to disclose.

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Correspondence to Toshio Uraoka.

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Uraoka, T., Higashi, R., Kato, J. et al. Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age. Surg Endosc 25, 3000 (2011). https://doi.org/10.1007/s00464-011-1660-y

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Keywords

  • Colorectum
  • Elderly
  • EMR
  • Endoscopic mucosal resection
  • Endoscopic submucosal dissection
  • ESD