Clinical outcome and long‑term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged 75 years or older: a retrospective observational study.

Abstract

Purpose: To determine the clinical outcomes of endoscopic submucosal dissection (ESD) for colorectal tumors in older patients and predictors of mortality.

Methods: We retrospectively evaluated 207 lesions in 195 consecutive older patients aged ≥ 75 years who underwent ESD for colorectal tumors between January 2007 and December 2018. Outcomes of ESD were evaluated, and the prognosis was assessed in terms of both curability and the patient's baseline physical condition as determined by several indices. Cox regression analyses were performed to identify factors associated with reduced overall survival (OS).

Results: Treatment outcomes included a median procedure time of 55 min, en bloc resection rate of 97%, histological en bloc resection rate of 92%, postoperative bleeding rate of 2.4%, and intraoperative perforation rate of 3.4%. Postoperative bleeding and intraoperative perforation could be treated conservatively. Delayed perforation occurred in one patient and required emergency surgery. Three-year OS was 99.4% and 5-year OS was 95.8%. Overall, three patients experienced recurrence (one local, two distant metastasis), and one patient died of primary cancer. Multivariate analysis identified the Charlson Comorbidity Index (CCI) score ≥ 3 as the only independent predictor of reduced OS (hazard ratio 4.26; 95% confidence interval 1.60-11.38; P = 0.004).

Conclusion: Our results suggest that colorectal ESD is safe and effective in older patients aged ≥ 75 years. There was a significant independent association of reduced OS with high CCI score, but not with curability by ESD. The CCI score should be considered when determining the indications for ESD in older patients.