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

 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  ;  Hyojin Park 
 Surgical Endoscopy , Vol.31(3) : 1376-1382, 2017 
Journal Title
 Surgical Endoscopy  
Issue Date
Aged ; Aged, 80 and over ; Comorbidity ; Early Detection of Cancer ; Electrocoagulation* ; Female ; Gastroscopy* ; Humans ; Male ; Neoplasm Invasiveness ; Reoperation ; Republic of Korea/epidemiology ; Retrospective Studies ; Stomach Neoplasms/mortality* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Survival Rate
Elderly patient ; Endoscopic resection ; Gastric cancer ; Non-curative resection
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. RESULTS: 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. CONCLUSIONS: 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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Park, Jae Jun(박재준)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Jung, Da Hyun(정다현)
Chung, Hyun Soo(정현수)
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