Long-Term Efficacy of Endoscopic Submucosal Dissection Compared with Surgery for Early Gastric Cancer: A Retrospective Cohort Study

Abstract

Background/AimsThis study aimed to compare the outcomes of endoscopic submucosal dissection (ESD) and gastrectomy based on the two sets of indications for ESD, namely guideline criteria (GC) and expanded criteria (EC).MethodsBetween January 2004 and July 2007, 213 early gastric cancer (EGC) patients were enrolled in this study. Of these patients, 142 underwent ESD, and 71 underwent gastrectomy. We evaluated the clinical outcomes of these patients according to the criteria.ResultsThe complication rates in the ESD and gastrectomy groups were 8.5% and 28.2%, respectively. The duration of hospital stay was significantly shorter in the ESD group than the gastrectomy group according to the GC and EC (p<0.001 and p<0.001, respectively). There was no recurrence in the ESD and gastrectomy groups according to the GC, and the recurrence rates in the ESD and gastrectomy groups were 4.7% and 0.0% according to the EC, respectively (p=0.279). The occurrence rates of metachronous cancer in the ESD and gastrectomy groups were 5.7% and 5.0% according to the GC (p=1.000) and 7.5% and 0.0% according to the EC (p=0.055), respectively.ConclusionsBased on safety, duration of hospital stay, and long-term outcomes, ESD may be an effective and safe first-line treatment for EGC according to the EC and GC.

A prediction model for lymph node metastasis in early‐stage gastric cancer: Toward tailored lymphadenectomy

“…Based on these findings, gastric cancer within “absolute indications” is generally agreed to be curable by endoscopic resection without gastrectomy and lymphadenectomy . Although endoscopic resection has similar outcomes to gastrectomy in gastric cancer patients, it cannot avoid potential LNM . To navigate metastatic LN, SNN had been suggested to reduce concerns about LNM after endoscopic resection and unnecessary gastrectomy .…”

Gastric cancer treated by endoscopic submucosal dissection or endoscopic mucosal resection in Japan from 2004 through 2006: JGCA nationwide registry conducted in 2013

“…In our study, the 5-year disease-specific survival rate was nearly 100% in patients who underwent curative resection for absolute indication lesions or expanded indication lesions. In studies comparing ESD with surgery, the overall survival rate after ESD was similar to that after surgery, and the benefit of ESD as compared with surgery included fewer late complications and a shorter hospital stay [15,16].…”

Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer

“…Long-term survival of EGC patients undergoing ESD with expanded criteria was similar to that in patients undergoing ESD with guideline criteria. In addition, ESD can achieve similar oncological and better perioperative outcomes when compared with radical gastrectomy for treatment of EGC [7,18]. Therefore, ESD is accepted as an initial treatment for EGC with a negligible risk of lymph node metastasis.…”