Long-term outcomes after curative endoscopic submucosal dissection vs. gastrectomy in late elderly patients aged ≥75 years with early gastric cancer

This study compares outcomes of endoscopic submucosal dissection (ESD) with those of gastrectomy in late elderly patients aged ≥75 years with early gastric cancers (EGCs) that meet the curative resection criteria. We included 4,241 elderly EGC patients treated with either ESD (n=4,083) or gastrectomy (n=158) between 2010 and 2020. The primary outcome was overall survival (OS), and was investigated in the overall cohort and the 4-to-1 propensity score (PS)-matched cohort. During a median follow-up of 6.6 years, the 5-year OS rates were 84.8% and 82.9% in the ESD and surgery groups, respectively; and the OS did not differ between the two groups in the overall and PS-matched cohorts (all P> 0.05 by the log-rank test). In the PS-matched cohort, the multivariate analyses showed that ESD was not a risk factor for overall mortality (adjusted hazard ratio, 0.77; 95% confidence interval, 0.57–1.04). The ESD group had fewer adverse events (AEs) (7.6% vs. 12.0%; P=0.044) than the surgery-group. In conclusion, long-term outcomes after ESD were comparable to those after gastrectomy in EGCs meeting the curative resection criteria with acceptable treatment-related AEs in late elderly EGC patients.