Comparison of long-term outcome between endoscopic submucosal dissection and surgical resection for early gastric cancer.

Abstract

144 Background: The aim of this study is to evaluate the long-term clinical and oncologic outcome of ESD for differentiated EGC of an expanded indication compared to surgical resection. Methods: Retrospective analyses were performed in patients who underwent ESD or surgical resection for EGC of an expanded indication from 2006 and 2008 in Incheon St. Mary’s Hospital, Seoul St. Mary’s Hospital, Yeouido St. Mary’s Hospital, and St. Paul’s Hospital. First arm study was performed according to pre-ESD diagnosis including pathologic diagnosis and endoscopic findings. Second arm study was obtained from post-ESD final pathologic result. All the patients were checked with endoscopy and stomach CT regularly at least 5 years. Clinical outcomes, disease free survival and overall survival were compared between the ESD group and surgical resection group in each arm. Results: In first arm study, 41 patients who received ESD and 106 patients who received surgical resection were enrolled. Metachronous recur was found in 4 patients among ESD group and in 2 patients among surgical resection group during the follow up period. There was no local recurrence in both groups. The disease free survival was not different between the two groups (ESD vs surgical resection; 87.8 vs 95.3%, p=0.291). The 5-year overall survival rate was 100% in both groups. In second arm study, 74 patients who received ESD and 165 patients who received surgical resection were enrolled. Metachronous recur was found in 5 patients among ESD group and in 2 patients among surgical resection group during the follow up period. Local recurrence did not occur in both groups. Surgical resection group was superior to ESD group in disease free survival (97.6% vs 87.6%, p=0.002). The 5-year overall survival rate was 100% in both groups. Conclusions: ESD for EGC might be acceptable considering the overall survival rates. However, intensive surveillance should be performed to find the metachronous recur after ESD.

Endoscopic Resection Versus Surgical Resection for Early Gastric Cancer

“…Local recurrence was reported in 9 studies. 8 – 10 , 19 , 21 , 24 – 26 , 29 The local recurrence rate was higher in the ER group (13/1098) than in the SR group (1/1300) (RD 0.01, 95% CI 0.00–0.02, P = 0.01) (Figure 9 ), and no heterogeneity was detected among the studies ( P = 0.30, I 2 = 16%).…”

“…Upon the full text review, 67 studies were excluded for the following reasons: 41 did not compare ER and SR; 18 were editorials and reviews; 3 studies did not provide the outcomes of interest; 2 studies included other types of gastric tumors or benign lesions apart from EGC; and 3 studies were published on the basis of the same data. Thus, the remaining 19 studies 7 – 10 , 15 – 29 (15 full text articles and 4 abstracts), including 3871 patients in the ER group and 2247 patients in the SR group, were eligible for the meta-analysis. All included studies were nonrandomized controlled trials and were conducted in Asian countries, including China, Japan, and Korea.…”

“…The 3, 5, and 10-year OS rates were obtained in 12 studies, 7 – 10 , 15 , 16 , 23 – 28 13 studies, 7 – 10 , 15 , 21 – 25 , 27 – 29 and 3 studies, 15 , 24 , 27 respectively. Meta-analyses of all these studies revealed no statistically significant difference in OS between ER and SR after 3 years (RR 1.00, 95% CI 0.98–1.01, P = 0.63), 5 years (RR 1.00, 95% CI 0.98–1.02, P = 0.84), and 10 years (RR 0.94, 95% CI 0.87–1.01, P = 0.10) (Figure 2 ).…”

“…Nine studies 7 – 10 , 15 , 18 , 19 , 24 , 29 described the development of metachronous lesions after ER and SR for EGC. The incidence of metachronous lesions was higher in the ER group (82/1165) than in the SR group (13/1462) (RR 6.81, 95% CI 3.80–12.19, P < 0.0001) (Figure 10 ), and there was no heterogeneity among the studies ( P = 0.98, I 2 = 0.0%).…”