Long-term outcome of endoscopic submucosal dissection is comparable to that of surgery for early gastric cancer: a propensity-matched analysis

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 21; no. 1; pp. 133 - 143
• Main Authors: Jeon, Hye Kyung, Kim, Gwang Ha, Lee, Bong Eun, Park, Do Youn, Song, Geun Am, Kim, Dae Hwan, Jeon, Tae Yong
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Cancer Research; Data processing; Endoscopy; Gastric cancer; Gastroenterology; Medicine; Medicine & Public Health; Oncology; Original Article; Surgery; Surgical Oncology; Survival; Endoscopic submucosal dissection; Gastrectomy; Early gastric cancer; Survival
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-017-0719-4

Background Data concerning the long-term outcomes of endoscopic submucosal dissection (ESD) versus surgery for early gastric cancer (EGC) are limited. We aimed to compare the long-term outcomes of ESD and surgery for patients with EGC. Methods Data were reviewed from patients treated by ESD or surgery for EGC in 2005–2010. The primary outcome was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), disease-free survival (DFS), recurrence-free survival (RFS), treatment-related complications, and hospital stay duration. Results Among 617 patients, 342 underwent ESD and 275 underwent surgery. The 5-year OS rates were similar between the ESD group and the surgery group (96.9% vs 98.1%, P  = 0.581). In a propensity-score-matched analysis of 117 pairs, there were no significant differences in the OS rates (96.5% vs 99.1%, P  = 0.125) and DSS rates (100% vs 99.1%, P  = 0.317) between the ESD group and the surgery group. The ESD group had a significantly lower DFS rate (90.3% vs 98.0%, P  = 0.002), a significantly lower RFS rate (95.1% vs 98.0%, P  = 0.033), a significantly higher early complication rate (6.7% vs 1.5%, P  < 0.001), a significantly lower late complication rate (0% vs 9.1%, P  < 0.001), and a significantly shorter median hospital stay (3 days vs 10 days, P  < 0.001) than the surgery group. Conclusions ESD and surgery have comparable OS rates in patients with EGC. ESD has benefits, including a lower late complication rate and shorter hospital stay. However, RFS and DFS rates might be lower after ESD than after surgery.