Endoscopic resection (ER) provides organ conserving treatment for large colorectal superficial neoplastic lesions (CSNL), allowing many patients to avoid surgery. Although ER is widely practised, little is known about outcomes in very elderly patients who may benefit the most from avoiding major surgery. The few studies examining outcomes in the elderly originate from eastern expert centres using ESD or use a relatively young definition of elderly. We aimed to compare outcomes of ER in very elderly compared to younger patients.Methods
Colorectal ERs of large (≥2 cm) CSNL performed at a tertiary institution were included. ER was performed for all lesions without overt invasive cancer regardless of size or location. Surveillance colonoscopy was performed at 3 months (SC1) and 12 months (SC2). Very elderly was defined as age ≥85 years. Outcomes were compared between patients aged ≥85 years and those <85 years.Results
570 ERs of lesions≥2 cm were included. Very elderly patients (n=57) had a mean age of 88 years vs 70 years for younger patients. There were no significant differences in mean lesion size (61 mm vs 52 mm, p=0.19) or location (p=0.74). The proportion of ERs using ESD/Hybrid ESD was similar (25% versus 26%, p=0.81). More patients≥85 years had covert invasive adenocarcinoma, although this was not significant (12% vs 7%, p=0.13).Results
More patients≥85 years experienced post procedure bleeding (8% vs 1%, p<0.001), but there was no difference in perforation rates (3% vs 3%, p=0.83) and no patients≥85 years required surgery for a complication. Recurrence was similar (15% vs 13%, p=0.79). Similar proportions underwent surgery for covert invasive adenocarcinoma (3.5% vs 2.9%, p=0.79) and for recurrence (2.4% vs 1.3%, p=0.55). Although they were equally likely to complete SC1 (p=0.42), patients≥85 years were significantly less likely to complete SC2 (OR 0.43, p=0.013), probably because of a lack of medical fitness or unwillingness to undergo further surveillance (OR 24.3, p<0.001) but not necessarily due to death (OR 1.13, p=0.87).Conclusions
ER for large CSNL is safe and effective in very elderly patients, who can be treated using similar techniques to younger patients with similar short term recurrence. Serious complications are rare. If surgery is indicated for covert adenocarcinoma or recurrence, it appears very elderly patients are equally likely to undergo surgery. However, significantly fewer very elderly patients are eligible for long-term follow up and therefore treatment should be tailored according to each patient’s specific lesion characteristics, symptoms and physiological fitness.