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Comparison of Long-Term Outcomes of Endoscopic Submucosal Dissection and Surgery for Early Gastric Cancer: a Systematic Review and Meta-analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Endoscopic submucosal dissection (ESD) is an endoscopic alternative to surgical resection of early gastric cancer (EGC). Besides offering both diagnostic and therapeutic capability, it has the benefits of reducing post-operative complications and provides fast recovery and better quality of life compared to surgical resection of neoplastic lesions. However, due to limitations of the procedure, its long-term outcomes are rather controversial.

Methods

This study has been carried out to investigate the long-term outcomes of ESD which includes the overall survival (OS), disease-free survival (DFS), and recurrence rate. The following databases were used to search for articles published until February 2018: Medline, Cochrane Library, PubMed, Web of Science, and EBSCO.

Results

A total of 13 eligible studies covering 4986 patients were selected for a meta-analysis based on specified inclusion and exclusion criteria. The difference of OS and disease-specific survival (DSS) between ESD and surgical treatment was not statistically significant (RR = 0.90, 95% CI = 0.68–1.19, p = 0.46; RR = 0.40, 95% CI = 0.15–1.03, p = 0.06, respectively). However, DFS in the ESD group was much lower than that in the surgery group (RR = 3.40, 95% CI = 2.39–4.84, p < 0.001). In terms of the treatment after recurrence, the proportion of patients who could receive radical treatment was significantly higher in the ESD than that in the gastrectomy (OR = 5.27, 95% CI = 2.35–11.79, p < 0.001).

Conclusions

This meta-analysis showed that ESD might be an alternative treatment option to surgery for patients with EGC in Asian countries. But a close surveillance program after ESD is of necessity, considering the higher possibility of tumor recurrence after ESD.

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Data Availability

The datasets supporting the conclusions of this article are included within the article.

Abbreviations

ESD:

endoscopic submucosal dissection

ER:

endoscopic resection

EMR:

endoscopic mucosal resection

EGC:

early gastric cancer

GC:

gastric cancer

LNM:

lymph node metastasis

OS:

overall survival

DSS:

disease-specific survival

DFS:

disease-free survival

RR:

risk ratio

OR:

odds ratio

CI:

confidence interval

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Authors and Affiliations

  1. Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China

    Lihu Gu

  2. Monash University School of Public Health and Preventive Medicine, Melbourne, Australia

    Parikshit A. Khadaroo

  3. Department of Surgical Oncology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China

    Liangliang Chen

  4. Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China

    Xinlong Li, Hepan Zhu, Xin Zhong & Junhai Pan

  5. Affiliated Hospital of Medical School Ningbo University and Ningbo City Third Hospital, No. 247, Renming Road, Ningbo, 315020, Zhejiang, China

    Manman Chen

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Contributions

Lihu Gu and Manman Chen assisted the conception and design. Lihu Gu and Liangliang Chen acquired the necessary data. Xinlong Li and Hepan Zhu assisted with statistical analysis and interpretation of data and provided critical revision of drafts. Parikshit A. Khadaroo and Manman Chen assisted with abstracts selection and also checked meta-data against the included manuscripts. Lihu Gu and Xin Zhong drafted the manuscript. Junhai Pan assisted with conception and design, assisted with statistical analysis and interpretation of data, and provided critical revision of drafts. All authors read and approved the final manuscript.

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Correspondence to Manman Chen.

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Electronic Supplementary Material

Supplementary Fig. 1

Begg’s and Egger’s funnel plot with 95% CI for OS publication bias testing. (PNG 124 kb)

High resolution image (TIF 689 kb)

Supplementary Fig. 2

Sensitivity analyses of the studies for OS. (PNG 135 kb)

High resolution image (TIF 620 kb)

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Gu, L., Khadaroo, P.A., Chen, L. et al. Comparison of Long-Term Outcomes of Endoscopic Submucosal Dissection and Surgery for Early Gastric Cancer: a Systematic Review and Meta-analysis. J Gastrointest Surg 23, 1493–1501 (2019). https://doi.org/10.1007/s11605-019-04227-8

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