ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Comparison of Long-Term Outcomes After Non-curative
Endoscopic Resection in Older Patients with Early Gastric Cancer
Jeung Hui Pyo, MD
, Hyuk Lee, MD, PhD
, Byung-Hoon Min, MD, PhD
, Jun Haeng Lee, MD, PhD
Kyoung-Mee Kim, MD, PhD
, Heejin Yoo, MS
, Soohyun Ahn, PhD
, Ji Yeong An, MD, PhD
, Min Gew Choi, MD,
, Jun Ho Lee, MD, PhD
, Tae Sung Sohn, MD, PhD
, Jae Moon Bae, MD, PhD
, Jae J. Kim, MD, PhD
Sung Kim, MD, PhD
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;
Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea;
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Background. Limited data exist that describe the long-
term outcomes from additional surgery following non-cu-
rative endoscopic resection (ER) of early gastric cancer
(EGC) in older people. This study aimed to determine the
appropriate treatment strategy for these patients.
Methods. We analyzed data from 2895 patients who
underwent ER for EGC, of whom 451 (15.6%) had non-
curative resections followed by curative surgery or
surveillance only. Of these patients, 138 were older
(aged C70 years). We compared the long-term outcomes
of the different treatment strategies in the older patients
with non-curative resections for EGC, and the outcomes of
each treatment strategy, with those in younger patients.
Results. The older patients underwent curative resections,
non-curative resections with surgery, or non-curative
resections with surveillance, and the 5-year disease-speciﬁc
survival (DSS) rates were 100, 100, and 73%, respectively.
There was a trend toward signiﬁcance for DSS in favor of
the non-curative resections with surgery group compared
with the non-curative resections with surveillance-only
group (p = 0.069). Among those who did not undergo
additional surgery, the older patients had worse DSS than
the younger patients, and patients who underwent addi-
tional surgery had better DSS, irrespective of their ages.
Multivariable analysis adjusted for other-cause mortality
generated similar results. Overall survival and recurrence-
free survival did not differ according to treatment strategy,
and perioperative morbidity and mortality did not differ
signiﬁcantly according to age.
Conclusions. In older patients with non-curatively resec-
ted EGC, additional surgery demonstrated a trend toward
better DSS, and perioperative complications did not
Since the incidence of gastric cancer increases with age,
changing demographics and increasing life expectancies
will augment the number of older people who are con-
fronted by gastric cancer.
Endoscopic resection (ER) is
currently accepted as the standard treatment for early
gastric cancers (EGCs) that meet the absolute or expanded
criteria (electronic supplementary Fig. 1),
and is feasible
and safe in older patients.
However, following patho-
logic evaluations, between 15.3 and 16.7% of the resected
specimens are reported as non-curative resections.
Additional surgery is generally recommended as the stan-
dard of care for patients with non-curative resections
because of the risk of lymph node metastasis. Nevertheless,
there are concerns regarding the reduction in functional
reserve that is required to overcome the physical and
emotional stress associated with surgery in older patients.
Whether older patients beneﬁt from the additional surgery
has not yet been established.
Electronic Supplementary Material The online version of this
article (doi:10.1245/s10434-017-5888-1) contains supplementary
material, which is available to authorized users.
Ó Society of Surgical Oncology 2017
First Received: 10 November 2016;
Published Online: 17 May 2017
H. Lee, MD, PhD
Ann Surg Oncol (2017) 24:2624–2631