Long-term Survival Following Endoscopic Submucosal Dissection Versus Gastrectomy in Early Gastric Cancer Patients Aged 75 Years and Above: A National Retrospective Cohort Study in Korea

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PURPOSE: Despite a growing older adult population, few studies have compared the long-term outcomes of endoscopic submucosal dissection (ESD) with those of gastrectomy. This study examines long-term survival among older patients with early gastric cancer (EGC) treated with ESD versus gastrectomy. MATERIALS AND METHODS: This retrospective cohort study used data from the Korea Clinical Data Utilization Network for Research Excellence. Patients aged ≥75 with stage IA gastric cancer (diagnosed 2014-2015) who underwent ESD or gastrectomy were followed for 5 years. All-cause and cause-specific mortality were assessed using Cox proportional hazard models and propensity score matching. RESULTS: Of the 442 patients (ESD, 269; gastrectomy, 173), the 5-year overall survival rates were 85.9% for ESD and 80.9% for gastrectomy (P=0.140). In patients aged ≥80, gastrectomy showed higher risks of total (adjusted hazard ratio [aHR], 3.29; 95% CI, 1.70-6.35) and gastric cancer-specific death (aHR, 7.18; 95% CI, 2.08-24.82) compared with ESD. In mucosa-confined lesions, gastrectomy also showed increased gastric cancer-specific mortality (aHR, 6.11; 95% CI, 1.93-19.35). The survival benefit of ESD was comparable to that of gastrectomy among patients aged 75-79 years and those with confined submucosal lesions. CONCLUSIONS: ESD may offer better outcomes than gastrectomy among older patients with stage IA gastric cancer, particularly those aged ≥80 or with mucosa-confined lesions. ESD and gastrectomy may provide similar survival outcomes among patients aged 75-79 years and those with submucosa-confined lesions. These findings support the use of adaptive treatment strategies in older patients with EGC.

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