Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer

doi:10.4251/wjgo.v9.i10.416

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Oct 15, 2017; 9(10): 416-422
Published online Oct 15, 2017. doi: 10.4251/wjgo.v9.i10.416

Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer

Yoshihiro Otsuka, Kazuya Akahoshi, Kayoko Yasunaga, Masaru Kubokawa, Junya Gibo, Shigeki Osada, Kayo Tokumaru, Kazuaki Miyamoto, Takao Sato, Yuki Shiratsuchi, Masafumi Oya, Hidenobu Koga, Eikichi Ihara, Kazuhiko Nakamura

Yoshihiro Otsuka, Kazuya Akahoshi, Masaru Kubokawa, Junya Gibo, Shigeki Osada, Kayo Tokumaru, Kazuaki Miyamoto, Takao Sato, Yuki Shiratsuchi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan

Kayoko Yasunaga, Diagnosis Procedure Combination Coding Management Office, Aso Iizuka Hospital, Iizuka 820-8505, Japan

Masafumi Oya, Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan

Hidenobu Koga, Clinical Research Supportive Office, Aso Iizuka Hospital, Iizuka 820-8505, Japan

Eikichi Ihara, Kazuhiko Nakamura, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

Author contributions: Otsuka Y and Akahoshi K contributed equally to this work; Yasunaga K, Shiratsuchi Y and Koga H collected and analyzed the data; Otsuka Y, Akahoshi K, Kubokawa M, Gibo J, Osada S, Tokumaru K, Miyamoto K, Sato T, Oya M, Ihara E and Nakamura K performed the research; Otsuka Y wrote the paper; all authors have read and approved the final version to be published.

Institutional review board statement: The study was reviewed and approved by the Iizuka Hospital.

Informed consent statement: The ethics committee of Aso Iizuka Hospital approved this study (registration No. 12120). Written informed consent was obtained from all patients.

Conflict-of-interest statement: Kazuya Akahoshi and Hidefumi Akahane (Fujifilm) have applied for a patent in Europe for the CC described in this article. Japan, China, and the United States have already granted patents.

Data sharing statement: Informed consent was not obtained for data sharing, and no additional data are available.

Correspondence to: Kazuya Akahoshi, MD, PhD, Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio, Iizuka 820-8505, Japan. kakahoshi2@aol.com

Telephone: +81-948-223800 Fax: +81-948-298747

Received: June 7, 2017
Peer-review started: June 12, 2017
First decision: July 11, 2017
Revised: July 24, 2017
Accepted: August 2, 2017
Article in press: August 4, 2017
Published online: October 15, 2017
Processing time: 127 Days and 7.8 Hours

Abstract

AIM

To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter (ESDCC) in older patients.

METHODS

We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients (> 80 years, n = 64) and non-older patients (≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status (PS) before and after ESDCC, and financial cost of admission.

RESULTS

The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease (P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients (100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications (i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization (11.4 and 10.7 d, respectively) and financial cost of admission (657040 JPY and 574890 JPY, respectively).

CONCLUSION

ESDCC has a good clinical outcome in older patients.

Keywords: Older patients; Clutch Cutter; Endoscopic submucosal dissection; Early gastric cancer; Financial cost; Duration of hospitalization

Core tip: No previous reports have described the clinical outcomes of endoscopic submucosal dissection using the Clutch Cutter (ESDCC) for older patients with early gastric cancer (EGC). The present study evaluated the clinical outcomes, including medical economics, associated with ESDCC for older patients. There was no significant difference between older patients and non-older patients in the rate of ESDCC-related complications. There was also no significant difference between older and non-older patients in the mean duration of hospitalization and medical economics. We conclude that ESDCC is safe and effective for older and non-older patients with EGC.