Gut Liver.  2014 Sep;8(5):519-525. 10.5009/gnl13061.

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

• Kim DY
• Hong SJ
• Cho GS
• Jeong GA
• Kim HK
• Han JP
• Lee YN
• Ko BM
• Lee MS

• KMID: 2070062
• DOI: http://doi.org/10.5009/gnl13061

Abstract

BACKGROUND/AIMS
This 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).
METHODS
Between 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.
RESULTS
The 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.
CONCLUSIONS
Based 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.

Keyword

Endoscopic submucosal dissection; Gastrectomy; Long-term outcome; Indication

MeSH Terms

Adult
Aged
Dissection
Early Detection of Cancer
*Endoscopy, Gastrointestinal
Female
*Gastrectomy
Gastric Mucosa/*surgery
Humans
Length of Stay
Male
Middle Aged
Neoplasm Recurrence, Local/epidemiology
Patient Safety
Retrospective Studies
Stomach Neoplasms/*surgery/therapy
Treatment Outcome