Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Additive treatment improves survival in elderly patients after non-curative endoscopic resection for early gastric cancer

  • 395 Accesses

  • 4 Citations


Background and study aims

Endoscopic resection (ER) is accepted as a curative treatment option for selected cases of early gastric cancer (EGC). Although additional surgery is often recommended for patients who have undergone non-curative ER, clinicians are cautious when managing elderly patients with GC because of comorbid conditions. The aim of the study was to investigate clinical outcomes in elderly patients following non-curative ER with and without additive treatment.

Patients and methods

Subjects included 365 patients (>75 years old) who were diagnosed with EGC and underwent ER between 2007 and 2015. Clinical outcomes of three patient groups [curative ER (n = 246), non-curative ER with additive treatment (n = 37), non-curative ER without additive treatment (n = 82)] were compared.


Among the patients who underwent non-curative ER with additive treatment, 28 received surgery, three received a repeat ER, and six experienced argon plasma coagulation. Patients who underwent non-curative ER alone were significantly older than those who underwent additive treatment. Overall 5-year survival rates in the curative ER, non-curative ER with treatment, and non-curative ER without treatment groups were 84, 86, and 69 %, respectively. No significant difference in overall survival was found between patients in the curative ER and non-curative ER with additive treatment groups. The non-curative ER groups were categorized by lymph node metastasis risk factors to create a high-risk group that exhibited positive lymphovascular invasion or deep submucosal invasion greater than SM2 and a low-risk group without risk factors. Overall 5-year survival rate was lowest (60 %) in the high-risk group with non-curative ER and no additive treatment.


Elderly patients who underwent non-curative ER with additive treatment showed better survival outcome than those without treatment. Therefore, especially with LVI or deep submucosal invasion, additive treatment is recommended in patients undergoing non-curative ER, even if they are older than 75 years.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS (2013) Prediction of cancer incidence and mortality in Korea. Cancer Res Treat 45(1):15–21

  2. 2.

    Lim D, Ha M, Song I (2014) Trends in the leading causes of death in Korea, 1983–2012. J Korean Med Sci 29(12):1597–1603

  3. 3.

    Park CH, Lee H, Kim DW, Chung H, Park JC, Shin SK, Hyung WJ, Lee SK, Lee YC, Noh SH (2014) Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc 80(4):599–609

  4. 4.

    Japanese Gastric Cancer A (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123

  5. 5.

    Kusano C, Iwasaki M, Kaltenbach T, Conlin A, Oda I, Gotoda T (2011) Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? long-term comparative outcomes. Am J Gastroenterol 106(6):1064–1069

  6. 6.

    From the Centers for Disease Control and Prevention (2003) Public health and aging: trends in aging. United States and worldwide. JAMA 289(11):1371–1373

  7. 7.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

  8. 8.

    Damhuis RA, Tilanus HW (1995) The influence of age on resection rates and postoperative mortality in 2773 patients with gastric cancer. Eur J Cancer 31A(6):928–931

  9. 9.

    Lawrence W Jr, Menck HR, Steele GD Jr, Winchester DP (1995) The National cancer data base report on gastric cancer. Cancer 75(7):1734–1744

  10. 10.

    Janes RH Jr, Niederhuber JE, Chmiel JS, Winchester DP, Ocwieja KC, Karnell JH, Clive RE, Menck HR (1996) National patterns of care for pancreatic cancer: results of a survey by the commission on cancer. Ann Surg 223(3):261–272

  11. 11.

    Benhamiche AM, Faivre J, Tazi AM, Couillault C, Villing AL, Rat P (1997) Time trends in diagnostic strategy, treatment, and prognosis of gastric cancer in the elderly: a population based study. Eur J Cancer Prev 6(1):71–77

  12. 12.

    Roviello F, Marrelli D, De Stefano A, Messano A, Pinto E, Carli A (1998) Complications after surgery for gastric cancer in patients aged 80 years and over. Jpn J Clin Oncol 28(2):116–122

  13. 13.

    Matsushita I, Hanai H, Kajimura M, Tamakoshi K, Nakajima T, Matsubayashi Y, Kanek E (2002) Should gastric cancer patients more than 80 years of age undergo surgery? comparison with patients not treated surgically concerning prognosis and quality of life. J Clin Gastroenterol 35(1):29–34

  14. 14.

    Lambert R (2005) Treatment of early gastric cancer in the elderly: leave it, cut out, peel out? Gastrointest Endosc 62(6):872–874

  15. 15.

    Katai H, Sasako M, Sano T, Fukagawa T (2004) Gastric cancer surgery in the elderly without operative mortality. Surg Oncol-Oxford 13(4):235–238

  16. 16.

    Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Yahagi N, Omata M (2007) Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population. J Gastroenterol Hepatol 22(3):311–314

  17. 17.

    Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, Shikuwa S (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22(3):311–317

  18. 18.

    Tokioka S, Umegaki E, Murano M, Takeuchi N, Takeuchi T, Kawakami K, Yoda Y, Kojima Y, Higuchi K (2012) Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients. J Gastroenterol Hepatol 27(Suppl 3):63–69

  19. 19.

    Oda I, Gotoda T, Sasako M, Sano T, Katai H, Fukagawa T, Shimoda T, Emura F, Saito D (2008) Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg 95(12):1495–1500

  20. 20.

    da Jung H, Park YM, Kim JH, Lee YC, Youn YH, Park H, Lee SI, Kim JW, Choi SH, Hyung WJ, Noh SH (2013) Clinical implication of endoscopic gross appearance in early gastric cancer: revisited. Surg Endosc 27(10):3690–3695

Download references

Author information

Correspondence to Yong Chan Lee.

Ethics declarations


Drs. Da Hyun Jung, Yong Chan Lee, Jie-Hyun Kim, Sang Kil Lee, Sung Kwan Shin, Jun Chul Park, Hyunsoo Chung, Jae Jun Park, Young Hoon Youn, and Hyojin Park have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jung, D., Lee, Y.C., Kim, J. et al. Additive treatment improves survival in elderly patients after non-curative endoscopic resection for early gastric cancer. Surg Endosc 31, 1376–1382 (2017).

Download citation


  • Gastric cancer
  • Elderly patient
  • Endoscopic resection
  • Non-curative resection