Gut Liver.
2018 Jul;12(4):402-410. 10.5009/gnl17414.
Long-Term Clinical Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study
- Affiliations
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- 1Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Korea.
- 2National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
- 3Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
- 4Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.
- 5Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
- 6Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 7Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea. seolsymd@hanmail.net
- 8Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- 9Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea.
- 10Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
- 11Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 12Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 13Department of Internal Medicine, Institute of Digestive Diseases and Nutrition, Korea University College of Medicine, Seoul, Korea.
- KMID: 2417306
- DOI: http://doi.org/10.5009/gnl17414
Abstract
- BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) has been regarded as a curative treatment for early gastric cancer (EGC) in indicated cases. The aim of this study was to evaluate the nationwide long-term clinical outcomes of ESD for EGC in Korea.
METHODS
A prospective multicenter cohort study was performed to evaluate the long-term efficacy of ESD for EGC within pre-defined indications at 12 institutes in Korea. The cases that met the expanded criteria upon pathological review after ESD were followed for 5 years. The primary outcome was 5-year disease specific free survival.
RESULTS
Six hundred ninety-seven patients with 722 EGCs treated with ESD were prospectively enrolled and followed for 5 years. Complete resection was achieved in 81.3% of the cases, and curative resection was achieved in 86.1%. During the 5-year follow-up, the overall survival rate was 96.6%, and the disease specific free survival rate was 90.6%. Local recurrence developed in 0.9%, and metachronous tumor development occurred in 7.8%; both conditions were treated by endoscopic or surgical treatment. Distant metastasis developed in 0.5% during follow-up.
CONCLUSIONS
ESD showed excellent long-term clinical outcomes and can be accepted as a curative treatment for patients with EGC who meet the expanded criteria in final pathology studies.
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