Expanded Indication of EMR/ESD for Early Gastric Cancer in the Elderly Nobuhito Ito 1 , Kohei Funasaka 2 , Kazuhiro Furukawa 1 , Naomi Kakushima 1 , Satoshi Furune 1 , Hirotaka Wada 1 , Takashi Hirose 1 , Koichi Muroi 1 , Tomohiko Suzuki 1 , Takahiro Suzuki 1 , Emiko Hida 1 , Keiko Hirai 1 , Hiroyuki Shibata 1 , Masanao Nakamura 1 , Hiroki Kawashima 3 , Mitsuhiro Fujishiro 1 1Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan 2Department of Gastroenterology, Fujita Health University Hospital, Toyoake, Japan 3Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan Keyword: 早期胃癌 , ESD , 高齢者 , 長期予後 , 適応拡大 pp.61-69
Published Date 2021/1/25
DOI https://doi.org/10.11477/mf.1403202228
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 The indications of ESD(endoscopic submucosal dissection)for early gastric cancer are the lesions that provide equivalent treatment outcomes to surgery. A nationwide study revealed that an increasing gap existed between the overall survival rate and disease-specific survival rate following stage 1 gastric cancer surgery in the elderly. So, not only the disease factors but also the patient's factors should be considered comprehensively among the earlier mentioned elderly. In this study, the R0 resection of ESD has achieved a high rate in SM1 gastric cancer, with the risk of lymph node recurrence by the eCura system estimated at about 7% in most cases. Moreover, the independent factors of prognosis in the elderly following ESD for gastric cancer were CCI and sarcopenia-related factor PMI. Therefore, the indications of ESD in the elderly may also be applicable to SM1 gastric cancer, especially in patients who are unlikely to expect long-term prognosis based on CCI and PMI. To establish an indication of gastric ESD limited to the elderly, a further prospective study should be conducted.

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