Long-term prognosis after endoscopic submucosal dissection for esophageal cancer in elderly patients

Background The validity of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) in elderly persons with comorbidities remains unclear. This study evaluated the safety and efficacy of ESD and additional treatment for ESCC in elderly patients. Methods This study retrospectively evaluated the clinicopathological characteristics and clinical outcomes of 398 consecutive elderly patients (age ≥ 65 years) with 505 lesions who underwent ESD for ESCC at the Hiroshima University Hospital between September 2007 and December 2019. Additionally, the prognoses of 381 patients who were followed up for > 3 years were assessed. Results The mean patient age was 73.1 ± 5.8 years old. The mean procedure time was 77.1 ± 43.5 min. The histological en bloc resection rate was 98% (496/505). Postoperative stenosis, perforation, pneumonia, and delayed bleeding were conservatively treated in 82 (16%), 19 (4%), 15 (3%), and 5 (1%) patients, respectively. The 5-year overall and disease-specific survival rates were 78.9% and 98.0% (mean follow-up time: 71.1 ± 37.3 months). Multivariate analysis showed that age and the American Society of Anesthesiologists Classification of Physical Status class ≥Ⅲ (hazard ratio: 1.27; 95% confidence interval: 1.01–1.59, p = 0.0392) were independently associated with overall survival. A significantly lower overall survival rate was observed in the high-risk follow-up group compared to the low-risk follow-up and high-risk additional treatment groups (p < 0.01). However, no significant difference in disease-specific survival was observed between the three groups. Conclusions ESD is safe for ESCC treatment in patients aged ≥ 65 years. However, additional treatments should be considered based on the patient’s general condition.