Endoscopic Resection Compared with Gastrectomy to Treat Early Gastric Cancer: A Systematic Review and Meta-Analysis

Abstract

BackgroundEndoscopic resection and gastrectomy are treatment modalities for early gastric cancer, but their relative benefits and risks are unclear. We conducted a systematic review and meta-analysis to compare endoscopic resection and gastrectomy for treating early gastric cancer.MethodsWe searched PubMed, Embase, and the Cochrane Library until April 2015 for studies comparing endoscopic resection with gastrectomy for treatment of early gastric cancer. Outcome measures were five-year overall survival (OS), length of hospital stay and postoperative morbidity. We calculated pooled hazard ratio (HR), weighted mean difference (WMD) and odds ratio (OR) using random effects models.ResultsSix studies comprising 1,466 patients (618 endoscopic resection and 848 gastrectomy) met inclusion criteria. Five-year OS was similar between endoscopic resection and gastrectomy (HR, 1.06; 95%CI: 0.61 to 1.83). Endoscopic resection was associated with shorter hospital stays (WMD, -6.94; 95%CI: -7.59 to -6.29) and reduced overall postoperative morbidity (OR, 0.36; 95%CI: 0.17 to 0.74).ConclusionsWhile five-year OS is similar between endoscopic resection and gastrectomy, endoscopic resection offers a shorter hospital stay and fewer complications than gastrectomy for treating early gastric cancer. Endoscopic resection is a reasonable treatment for early gastric cancer with a negligible risk of lymph node metastasis.

CT-quantified muscle and fat change in patients after surgery or endoscopic resection for early gastric cancer and its impact on long-term outcomes

“…[2] Surgical resection is a conventional treatment for EGC and endoscopic resection was considered an alternative treatment method for surgical resection only for elderly patients and cancer of the upper stomach. [3,4] However, endoscopic resection is widely used for EGC as the proportion of EGC among stomach cancers has increased with the widespread use of screening endoscopy. [1,3] As the stomach is preserved after endoscopic resection, the chance of metachronous stomach cancer is higher than that after surgical resection.…”

“…[3,4] However, endoscopic resection is widely used for EGC as the proportion of EGC among stomach cancers has increased with the widespread use of screening endoscopy. [1,3] As the stomach is preserved after endoscopic resection, the chance of metachronous stomach cancer is higher than that after surgical resection. However, repeated endoscopic resection is possible.…”

A minimally invasive treatment for early GI cancers

“…44 Additionally, as endoscopic resection is associated with less morbidity, fewer procedure-related adverse events, and fewer complications, ESD could be used as the standard treatment for early gastric cancer. 47,48 The Western perspective on endoscopic submucosal dissection for gastric cancer Since the prevalence of gastric cancer in Western countries is significantly lower than in Japan and Korea, local data and experience Estimating the depth of invasion is mandatory Based on information from the Japanese Gastric Cancer Association, reference 9.…”

The Comparison between Endoscopic Submucosal Dissection and Surgery in Gastric Cancer: A Systematic Review and Meta-Analysis

“…In addition, the impossibility of regional lymph nodes removed during the ESD procedure is another major limitation, which may probably result in tumor recurrence and the invasive radical gastrectomy. Previous systematic review and meta-analysis revealed that the 5-year DFS survival rate may not be different between the endoscopic resection and surgery in the treatment of EGC as well [ 6 ].…”