[Should the elderly patients undergo additional surgery after non-curative endoscopic resection?]

Area of Science:

• Gastroenterology and Oncology
• Surgical Oncology
• Geriatric Medicine

Context:

• Endoscopic resection, including endoscopic mucosal dissection (ESD), is a standard treatment for early gastric cancer (EGC).
• Elderly patients (over 75 years) with non-curative resections often forgo radical surgery due to comorbidities or limited life expectancy.
• The optimal management strategy for elderly EGC patients with non-curative resection remains debated.

Purpose:

• To evaluate the necessity of radical surgery following non-curative endoscopic resection in elderly patients with EGC.
• To compare survival outcomes between elderly patients who undergo surgery versus those who do not after non-curative resection.
• To determine if elderly patients should receive the same surgical recommendations as younger patients after non-curative EGC resection.

Summary:

• A retrospective review analyzed 432 elderly patients (over 75) who underwent endoscopic resection for EGC.
• Survival rates were compared between curative resection, non-curative resection with surgery, and non-curative resection without surgery groups.
• Significant survival differences were observed, favoring surgical intervention in non-curative cases.

Impact:

• Reinforces the importance of radical surgery even in elderly patients with non-curative EGC resection.
• Suggests that age alone should not preclude surgical intervention when indicated for EGC.
• Contributes to evidence-based guidelines for managing elderly EGC patients with non-curative resection.