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Local Endoscopic Resection is Inferior to Gastrectomy for Early Clinical Stage T1a and T1b Gastric Adenocarcinoma: A Propensity-Matched Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of endoscopic resection (ER) in the management of subsets of clinical T1N0 gastric adenocarcinoma remains controversial. The aim of this study was to evaluate the outcome of ER versus gastrectomy in node-negative cT1a and cT1b gastric adenocarcinoma.

Methods

Data from the National Cancer Database (2010–2015) were used to identify patients with clinical T1aN0 (n = 2927; ER: n = 1157, gastrectomy: n = 1770) and T1bN0 (n = 2915; ER: n = 474, gastrectomy: n = 2441) gastric adenocarcinoma. Propensity score matching and Cox multivariable analyses were used to account for treatment selection bias.

Results

ER for cT1a and cT1b cancers was performed more frequently over time. The rates of node-positive disease in patients with cT1a and cT1b gastric adenocarcinoma were 5% and 18%, respectively. In the matched cohort, gastrectomy was associated with increased survival compared with ER for cT1a cancers (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66–0.95; p = 0.013), and corresponding 5-year survival for gastrectomy and ER was 72% and 66%, respectively (p = 0.013). For cT1b cancers, gastrectomy had a significantly longer survival compared with ER (HR 0.77, 95% CI 0.63–0.93; p = 0.008), and the corresponding 5-year survival for gastrectomy and ER was 60% and 50%, respectively (p = 0.013).

Conclusion

This study demonstrates ER is inferior in terms of long-term survival for clinical T1aN0 and T1bN0 gastric adenocarcinoma, despite current recommendations for ER in cT1 gastric cancers. Future research should seek to identify the subset of T1a and T1b cancers at low risk of nodal metastasis, and would thus maximally benefit from ER.

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Funding

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Authors and Affiliations

  1. Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle-upon-Tyne, UK

    Sivesh K. Kamarajah BMedSci, MBChB & Alexander W. Phillips MD, MA, FRCSEd

  2. Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Sivesh K. Kamarajah BMedSci, MBChB

  3. Department of Surgery and Cancer, Imperial College London, London, UK

    Sheraz R. Markar MRCS, MSc, MA, PhD, PhD

  4. Department of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden

    Sheraz R. Markar MRCS, MSc, MA, PhD, PhD

  5. School of Medical Education, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK

    Alexander W. Phillips MD, MA, FRCSEd

  6. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    George I. Salti MD

  7. Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA

    George I. Salti MD & Fadi S. Dahdaleh MD

Authors
  1. Sivesh K. Kamarajah BMedSci, MBChB
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  3. Alexander W. Phillips MD, MA, FRCSEd
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Correspondence to Fadi S. Dahdaleh MD.

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Kamarajah, S.K., Markar, S.R., Phillips, A.W. et al. Local Endoscopic Resection is Inferior to Gastrectomy for Early Clinical Stage T1a and T1b Gastric Adenocarcinoma: A Propensity-Matched Study. Ann Surg Oncol 28, 2992–2998 (2021). https://doi.org/10.1245/s10434-020-09485-4

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  • DOI: https://doi.org/10.1245/s10434-020-09485-4

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