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Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer

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Abstract

Background

Endoscopic submucosal dissection (ESD) is accepted as a standard treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. The aim of this study was to compare the short-term and long-term outcomes between ESD and surgery in patients with EGC that fulfilled the expanded indication of ESD on their final pathologic report.

Methods

We reviewed the clinical data of patients who underwent gastric ESD and surgery between January 2007 and December 2012. Patients with pathologically confirmed EGC that fulfilled the expanded indication of ESD on their final pathologic report were analyzed.

Results

Among 2023 patients, 817 (40.4%) underwent ESD and 1206 (59.6%) underwent surgery. The proportion of cases meeting the absolute indication was significantly higher in the ESD group than in the surgery group (66.0 vs. 26.2%). Lesions on the middle third, >3 cm in size, flat or depressed, and of undifferentiated histology were significantly more common in the surgery group than in the ESD group. The ESD group showed lower acute complication rates [8.1% (66 of 817) vs. 18.1% (218 of 1206), P ≤ 0.001] and procedure-related mortality [0 vs. 0.3% (4 of 1206), P = 0.153] than the surgical group. The annual incidence of recurrent gastric cancer was 2.18% in the ESD group and 0.19% in the surgery group. The 5-year overall and disease-specific survival rates were not significantly different between the ESD group and the surgery group (overall survival: 96.4 vs. 97.2%, P = 0.423; disease-specific survival: 99.6 vs. 99.2%, P = 0.203).

Conclusions

Although EGC lesions had poorer features in the surgery group than in the ESD group, ESD was comparable to surgery for EGCs that fulfilled the expanded indication of ESD, with lower rates of acute complication and comparable overall survival.

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Kyu Yeon Hahn, Yong Kang Lee, Jun Chul Park, Sung Kwan Shin, Yong Chan Lee & Sang Kil Lee

  2. Department of Internal Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Korea

    Chan Hyuk Park

  3. Department of Internal Medicine and Liver Research Institute, Seoul National University of Medicine, Seoul, Korea

    Hyunsoo Chung

  4. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Hyoung-Il Kim, Jae-Ho Cheong, Woo Jin Hyung & Sung Hoon Noh

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  1. Kyu Yeon Hahn
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  2. Chan Hyuk Park
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  12. Sang Kil Lee
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Correspondence to Sang Kil Lee.

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The authors (Hahn KY, Park CH, Lee YK, Chung H, Park JC, Shin SK, Lee YC, Kim HI, Cheong JH, Hyung WJ, Noh SH, Lee SK) declare that they have no conflicts of interest or financial ties to disclose.

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Hahn, K.Y., Park, C.H., Lee, Y.K. et al. Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer. Surg Endosc 32, 73–86 (2018). https://doi.org/10.1007/s00464-017-5640-8

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  • DOI: https://doi.org/10.1007/s00464-017-5640-8

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