Abstract: Objective To investigate the differences between endoscopic submucosal dissection (ESD) and surgical treatment in efficacy, complications, survival benefit in the elderly patients with single early gastric cancer who meet the absolute indications or expanded indications of ESD. Methods From January 2013 to December 2018, the clinical data of the elderly patients with single early gastric cancer who underwent ESD (ESD group, 148 cases) or surgical treatment (surgery group, 339 cases) in the First Affiliated Hospital with Nanjing Medical University were included in this retrospective study. The postoperative fasting time, operation time, hospitalization time, hospitalization expenses of the two groups were recorded and analyzed. The rates of en bloc resection, local recurrence, simultaneous recurrence, metachronous recurrence, and postoperative complications were compared between the two groups. Kaplan-Meier method was used to analyze the overall survival rate of the two groups. Results There were no significant differences in the rates of en bloc resection, local recurrence, simultaneous recurrence and metachronous recurrence. ESD group showed less postoperative fasting time (P＜0.01), operation time (P＜0.01), hospitalization time (P＜0.01), and hospitalization expenses (P＜0.01) than surgical group. The total incidence rate of the complications in ESD group was significantly lower than that in surgical group (3.38% vs 15.04%, P＜0.01). There was no significant difference in the 5-year complete survival rate between the two groups (95.9% vs 96.5%, P=0.531). Conclusions For the elderly patients with single early gastric cancer who meet the absolute indications or the expanded indications, there is no significant difference in efficacy between ESD and surgery treatment, while ESD group shows less postoperative fasting time, operation time, hospitalization time, hospitalization expenses, and lower incidence of complications, so ESD can be used as the preferred treatment.

Key words: aged, early gastric cancer, surgical treatment, endoscopicsubmucosal dissection, clinical effect