Skip to main content

Advertisement

SpringerLink
Log in

Propensity score-matched comparison of short-term and long-term outcomes between endoscopic submucosal dissection and surgery for treatment of early gastric cancer in a Western setting

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic submucosal dissection (ESD) is a standard treatment option for early gastric cancer (EGC) in Asia; however, data about ESD efficacy in Western populations are limited. Furthermore, outcomes of EGC treatment after ESD or surgery have not been compared in Western cohorts. This study aimed to compare short-term and long-term results of ESD and surgery for EGC.

Methods

This retrospective case–control study included patients with EGC treated in two largest cancer centers in Eastern Lithuania between 2005 and 2016. Propensity score nearest-neighbor 1:1 matching, based on clinicopathologic characteristics, was performed between patients who underwent ESD and surgery. The primary endpoint of the study was 5-year disease-free survival (DFS).

Results

Of 260 eligible patients, 42 (16.1%) underwent ESD. After matching, two well-balanced groups consisting of 42 patients in each were analyzed. The operation time (83 vs. 151 min., p = 0.001) and postoperative hospitalization stay (5.4 vs. 13.4 days, p = 0.001) was significantly shorter in the ESD group. 5-year DFS rate was significantly higher in the surgery group (97.6% vs. 77.5%, p = 0.002). However, this difference was reduced after exclusion of non-curative ESD cases (97.6% vs. 89.7%, p = 0.099). There was no significant difference in 5-year OS rate between the study groups (73.8% vs. 69.0%, p = 0.599).

Conclusions

ESD might be an excellent alternative to surgery for EGC if curative resection is achieved. Non-curative ESD is associated with poor DFS and high rate of recurrence. Additional surgery should be recommended after non-curative ESD whenever treatment-associated risk is acceptable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gotoda T, Ho K-Y, Soetikno R, Kaltenbach T, Draganov P (2014) Gastric ESD: current status and future directions of devices and training. Gastrointest Endosc Clin N Am 24(2):213–233

    Article  Google Scholar 

  2. Itoh H, Oohata Y, Nakamura K, Nagata T, Mibu R, Nakayama F (1989) Complete ten-year postgastrectomy follow-up of early gastric cancer. Am J Surg 158(1):14–16

    Article  CAS  Google Scholar 

  3. Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y et al (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 16(1):1–27

    Article  Google Scholar 

  4. An JY, Heo G-U, Cheong J-H, Hyung WJ, Choi SH, Noh SH (2010) Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: a retrospective cohort analysis. J Surg Oncol 102(1):77–81

    Article  Google Scholar 

  5. Yasunaga H, Horiguchi H, Kuwabara K, Matsuda S, Fushimi K, Hashimoto H et al (2013) Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity-matched analysis. Ann Surg 257(4):640–646

    Article  Google Scholar 

  6. Lee SS, Chung HY, Kwon OK, Yu W (2014) Quality of life in cancer survivors 5 years or more after total gastrectomy: a case-control study. Int J Surg Lond Engl 12(7):700–705

    Article  Google Scholar 

  7. Karanicolas PJ, Graham D, Gönen M, Strong VE, Brennan MF, Coit DG (2013) Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg 257(6):1039–1046

    Article  Google Scholar 

  8. Japanese Gastric Cancer Association (2014) Japanese gastric cancer treatment guidelines. Gastric Cancer 4(1):1–19

    Article  Google Scholar 

  9. Chiu PWY, Teoh AYB, To KF, Wong SKH, Liu SYW, Lam CCH et al (2012) Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 26(12):3584–3591

    Article  Google Scholar 

  10. Choi K-S, Jung H-Y, Choi KD, Lee GH, Song HJ, Kim DH et al (2011) EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 73(5):942–948

    Article  Google Scholar 

  11. Etoh T, Katai H, Fukagawa T, Sano T, Oda I, Gotoda T et al (2005) Treatment of early gastric cancer in the elderly patient: results of EMR and gastrectomy at a national referral center in Japan. Gastrointest Endosc 62(6):868–871

    Article  Google Scholar 

  12. Kim HS, Lee DK, Baik SK, Kim JM, Kwon SO, Kim DS et al (2000) Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerous lesions: comparison of its therapeutic efficacy with surgical resection. Yonsei Med J 41(5):577–583

    Article  CAS  Google Scholar 

  13. Fukunaga S, Machida H, Tominaga K, Tanaka H, Muguruma K, Ohira M et al (2012) Sa1654 short- and long-term prognosis of patients with early gastric cancer: comparative analysis between endoscopic submucosal dissection and surgical operation. Gastrointest Endosc 75(4):AB234–AB235

    Article  Google Scholar 

  14. Park CH, Lee H, Kim DW, Chung H, Park JC, Shin SK et al (2014) Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc 80(4):599–609

    Article  Google Scholar 

  15. Kim DY, Hong SJ, Cho GS, Jeong GA, Kim HK, Han JP et al (2014) Long-term efficacy of endoscopic submucosal dissection compared with surgery for early gastric cancer: a retrospective cohort study. Gut Liver 8(5):519–525

    Article  Google Scholar 

  16. Kim Y-I, Kim Y-W, Choi IJ, Kim CG, Lee JY, Cho S-J et al (2015) Long-term survival after endoscopic resection versus surgery in early gastric cancers. Endoscopy 47(4):293–301

    Article  CAS  Google Scholar 

  17. Russo A, Li P, Strong VE (2017) Differences in the multimodal treatment of gastric cancer: east versus west. J Surg Oncol 115(5):603–614

    Article  Google Scholar 

  18. Fukuhara S, Yabe M, Montgomery MM, Itagaki S, Brower ST, Karpeh MS (2014) Race/ethnicity is predictive of lymph node status in patients with early gastric cancer. J Gastrointest Surg 18(10):1744–1751

    Article  Google Scholar 

  19. Ikoma N, Blum M, Chiang YJ, Estrella JS, Roy-Chowdhuri S, Fournier K et al. (2017) Race is a risk for lymph node metastasis in patients with gastric cancer. Ann Surg Oncol 24:960

    Article  Google Scholar 

  20. Suzuki S, Gotoda T, Hatta W, Oyama T, Kawata N, Takahashi A et al (2017) Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis. Ann Surg Oncol 24(11):3353–3360

    Article  Google Scholar 

  21. Schumacher B, Charton J-P, Nordmann T, Vieth M, Enderle M, Neuhaus H (2012) Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife: a Western, single-center experience. Gastrointest Endosc 75(6):1166–1174

    Article  Google Scholar 

  22. Emura F, Mejía J, Donneys A, Ricaurte O, Sabbagh L, Giraldo-Cadavid L et al (2015) Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video). Gastrointest Endosc 82(5):804–811

    Article  Google Scholar 

  23. Pimentel-Nunes P, Mourão F, Veloso N, Afonso LP, Jácome M, Moreira-Dias L et al (2014) Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal. Endoscopy 46(11):933–940

    Article  Google Scholar 

  24. Catalano F, Trecca A, Rodella L, Lombardo F, Tomezzoli A, Battista S et al (2009) The modern treatment of early gastric cancer: our experience in an Italian cohort. Surg Endosc 23(7):1581

    Article  Google Scholar 

  25. Kondo A, de Moura EGH, Bernardo WM, Yagi OK, de Moura DTH, de Moura ETH et al (2015) Endoscopy vs surgery in the treatment of early gastric cancer: systematic review. World J Gastroenterol 21(46):13177–13187

    Article  CAS  Google Scholar 

  26. Lian J, Chen S, Zhang Y, Qiu F (2012) A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 76(4):763–770

    Article  Google Scholar 

  27. Bausys R, Bausys A, Vysniauskaite I, Maneikis K, Klimas D, Luksta M et al. (2017) Risk factors for lymph node metastasis in early gastric cancer patients: report from Eastern Europe country—Lithuania. BMC Surg 17(1):108

    Article  Google Scholar 

  28. Kawata N, Kakushima N, Takizawa K, Tanaka M, Makuuchi R, Tokunaga M et al (2017) Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection. Surg Endosc 31(4):1607–1616

    Article  Google Scholar 

  29. Suzuki H, Oda I, Abe S, Sekiguchi M, Nonaka S, Yoshinaga S et al (2017) Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series. Gastric Cancer 20(4):679–689

    Article  Google Scholar 

  30. Toya Y, Endo M, Nakamura S, Akasaka R, Kosaka T, Yanai S et al (2017) Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer. Gastrointest Endosc 85(6):1218–1224

    Article  Google Scholar 

Download references

Acknowledgements

R.B. and A.B contributed equally to this article. This study did not receive any funding. At the time of submission, abstract based on the same dataset as this article is prepared for submission to the European Society of Surgical Oncology (ESSO) 38th congress.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Vilnius University, Ciurlionio Str. 21, 03101, Vilnius, Lithuania

    R. Bausys, A. Bausys, J. Stanaitis, K. Maneikis, B. Bausys, E. Stratilatovas & K. Strupas

  2. Department of Abdominal Surgery and Oncology, National Cancer Institute, Santariskiu Str. 1, 08660, Vilnius, Lithuania

    R. Bausys, A. Bausys & E. Stratilatovas

  3. Center of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Santariskiu Str. 2, 08661, Vilnius, Lithuania

    J. Stanaitis

  4. School of Medicine, Georgetown University, Washington, DC, USA

    I. Vysniauskaite

  5. Center of Abdominal Surgery, Vilnius University Hospital Santaros Clinics, Santariskiu Str. 2, Vilnius, 08661, Lithuania

    K. Strupas

Authors
  1. R. Bausys
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bausys
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Stanaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Vysniauskaite
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Maneikis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Bausys
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Stratilatovas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. Strupas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Bausys.

Ethics declarations

Disclosures

All authors—R.Bausys, A.Bausys, J.Stanaitis, I.Vysniauskaite, K.Maneikis, B.Bausys, E.Stratilatovas, and K.Strupas—have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bausys, R., Bausys, A., Stanaitis, J. et al. Propensity score-matched comparison of short-term and long-term outcomes between endoscopic submucosal dissection and surgery for treatment of early gastric cancer in a Western setting. Surg Endosc 33, 3228–3237 (2019). https://doi.org/10.1007/s00464-018-06609-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-06609-6

Keywords

Search

Navigation