Comparison of postoperative complications rates of endoscopic submucosal dissection in patients of different age groups with lesions at different locations

Abstract

Objective To retrospectively analyze the characteristics of postoperative complications of endoscopic submucosal dissection (ESD) in patients of different age groups with lesions at different locations. Methods From January 2011 to October 2017, at The First Affiliated Hospital of Zhejiang University, clinical data of 1 688 patients who received ESD treatment (1 799 ESD operations) were collected. The lesions were located in the esophagus (n=232), stomach (n=1 225), duodenum (n=9), colon (n=152) and rectum (n=181). There were 500 patients (508 ESD operations) with underlying diseases, and 1 188 patients without underlying diseases. Most patients with lesions at stomach, esophagus and colon rectum, and these patients were divided into four age groups <45 years (n=202), 4559 years (n=643), 6074 years (n=744), and ≥75 years (n=99). The postoperative complications rates of ESD in different lesions among four age groups were compared. Chi-square test was performed for statistical analysis. Results From 2011 to 2017, the complication rates after ESD were 20.0% (8/40), 18.3% (21/115), 15.9% (35/220), 10.7% (31/291), 11.3% (40/355), 10.7% (41/384) and 10.7% (42/394), respectively, and the difference was not statistically significant (χ2=10.432, P=0.064). Further analysis revealed that the complication rates after ESD between 2011 and 2013 was significantly higher than that between 2014 and 2017 (17.1%, 64/375 vs. 10.8%, 154/1 424); and the difference was statistically significant (χ2=10.895, P<0.01). The complication rates of patients with lesions in the esophagus of<45 years group, 4559 years group, 6074 years group and ≥75 years group were 4.5% (1/22), 23.6% (17/72), 24.4% (31/127) and five cases (totally 11 cases). The complication rates of patients with lesions in the stomach of<45 years group, 4559 years group, 6074 years group and ≥75 years group were 19.2% (28/146), 14.2% (68/479), 15.8% (85/539) and 16.4% (10/61). The complication rates of lesions in the colon of<45 years group, 4559 years group, 6074 years group and ≥75 years group were one case (totally 12 cases), 3.4% (2/58), 10.9% (7/64) and five cases (totally 18 cases), respectively.The complication rates of lesions in the rectum of <45 years group, 4559 years group, 6074 years group and ≥75 years group were 3.3% (1/30), 10.4% (7/67), 19.4% (14/72) and two cases (totally 12 cases), respectively. There were significant differences in complication rates between different age groups with lesions in the esophagus (χ2=10.894, P=0.012) and the colon (χ2=13.540, P=0.004). In addition, the complication rates of patients with underlying diseases and without underlying diseases were 14.6% (74/508) and 12.5% (149/1 188), respectively, and there was no statistically significant difference (χ2=1.278, P=0.258). Conclusions The postoperative complications of ESD is closely associated with lesion location and age. For elderly patients, especially those with lesions in the esophagus and colon, paying more attention and strengthening the clinical practice can effectively reduce the incidence of complications. Key words: Postoperative complications; Hemorrhage; Endoscopic submucosal dissection; Perforation