Impact of age and comorbidities on colorectal endoscopic submucosal dissection outcomes: Large multicenter study in a Western cohort

Abstract

Background and study aims: Endoscopic submucosal dissection (ESD) has emerged as the standard treatment for colorectal lesions. Considering aging of the global population, we aimed to assess effectiveness and safety of colorectal ESD in patients aged ≥ 80 years compared with those aged 65 to 79 years in a large Western cohort.

Patients and methods: We retrospectively enrolled patients aged > 64 years undergoing colorectal ESD, classifying them into a very elderly group (VE-Group, aged > 80 years) and elderly group (E-Group, 65-79 years). Procedure outcomes and safety were compared between the VE-Group and E-Group and between patients with comorbidities and those who were healthy (1-CM-Group and H-Group).

Results: A total of 980 patients were included (269; 27.5% in the VE-Group and 711; 72.5% in the E-Group). En-bloc, R0, and oncological curative resection rates did not differ, nor did intra-procedure or post-procedure adverse events (AEs). Delirium occurrence was registered in VE-group [6 (2.2%) in VE-Group vs 1 (0.1%) in E-Group; P = 0.001; OR = 16.2, (95%CI:1.9-135.2)]. The 1-CM-Group had a higher rate of intra-procedure bleeding ( P = 0.001), delayed perforation ( P = 0.03), fever onset ( P < 0.001), and systemic infections ( P = 0.02) compared with the H-Group. Having one or more comorbidities was associated with increased overall AEs ( P < 0.001; OR 2.3, 95% CI 1.5-3.6).

Conclusions: Colorectal ESD is feasible in elderly patients. Physicians should consider delirium a possible AE in patients older than age 80 years. These findings, which bridge the gap between Asian and Western clinical data, underscore the importance of tailored pre-procedure and post-procedure assessments in a global clinical context.

Keywords: Colorectal cancer; Endoscopic resection (polypectomy, ESD, EMRc, ...); Endoscopy Lower GI Tract; Epidemiology; Polyps / adenomas / ....

Fig. 1

a Comparison of procedure-related AEs and overall AE occurrence in very elderly group vs. elderly group. b Comparison of procedure-related AEs and overall AE occurrence in 1-Comorbidity group vs. Healthy group.