Outcomes of additional surgery after endoscopic submucosal dissection with endoscopic curability C-2 for early gastric cancer in elderly patients aged ≥ 60 years

Abstract

Abstract Background: Patients with early gastric cancer whose pathological evaluation was eCuraC-2 after ESD had a high risk of lymph node metastasis and were recommended for further surgery. But previous studies showed that only 5.7-8.2% of patients with non-curative resection actually have lymph node metastasis. For elderly patients, whether additional surgery is beneficial needs to be further explored due to their poor physical fitness. Objectives: To compare the long-term outcome of additional surgery and follow-up in elderly patients with early gastric cancer and a pathological evaluation of eCuraC-2 after ESD, and analyze the factors affecting their survival. Design: A retrospective cohort study. Methods: The data of the patients at our center from April 2014 to September 2020 were retrospectively analyzed. The patients were divided into the follow-up group and additional surgery group. Propensity score matching was used to control for confounding factors between the two groups. The prognosis of the two groups was compared and the factors affecting survival were analyzed. Results: The follow-up group was older on average and had a higher incidence of ulcers, larger tumor diameters, and less involvement of SM2/SM3 compared to the additional surgery group. After propensity matching, there was no significant difference in the long-term outcomes between the two groups. Univariate and multivariate analysis revealed that the CCI (Charlson Comorbidity Index), PNI (prognostic nutritional index), and lymphovascular invasion were independent factors affecting OS (overall survival) and lymphovascular invasion was an independent factor affecting DSS (disease-specific survival) in elderly patients with early gastric cancer who underwent ESD and had a pathological evaluation of eCuraC-2. Conclusion: Elderly patients with early gastric cancer and a pathological evaluation of eCuraC-2 after ESD can be safely monitored with caution. Additionally, CCI, PNI, and lymphovascular invasion can be used to predict their long-term outcomes.