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Surgical Endoscopy

, Volume 26, Issue 12, pp 3584–3591 | Cite as

Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study

  • Philip Wai Yan ChiuEmail author
  • Anthony Yun Bun Teoh
  • Ka Fai To
  • Simon Kin Hung Wong
  • Shirley Yuk Wah Liu
  • Candice C. H. Lam
  • Man Yee Yung
  • Francis Ka Leung Chan
  • James Yun Wong Lau
  • Enders Kwok Wai Ng
Article

Abstract

Introduction

This study aims to compare perioperative outcomes and oncological clearance of endoscopic submucosal dissection (ESD) versus gastrectomy for treatment of early gastric cancer (EGC).

Methods

This is a retrospective cohort study including all cases of EGC or severe dysplasia treated at a university-affiliated hospital from 1993 to 2010. Preoperative endoscopic ultrasound and image-enhanced endoscopy were employed to determine depth of invasion. Clinical outcomes including baseline demographics, pathology, postoperative complication, and hospital stay, as well as 3-year survival were compared.

Results

From 1993 to 2010, 114 patients with severe dysplasia or EGC were treated: 40 of them received gastrectomy, while 74 received ESD. There was no difference in age, gender, comorbidity or American Society of Anesthesiologists grade between the two groups. Of patients in the gastrectomy group, 92.5 % presented with symptoms as compared with 27.0 % of those treated by ESD (p < 0.001). More patients in the ESD group had atrophic gastritis (31.1 vs 10 %; p = 0.009) and intestinal metaplasia (68.9 vs 55.0 %; p = 0.04). Patients treated by gastrectomy sustained longer operative time [265 (150–360) min] when compared with ESD [89.6 (45–360) min; p < 0.001]. They also had longer median hospital stay [9.9 (6–26) days vs 3.0 (2–10) days; p < 0.001]. There was no perioperative mortality, but the overall complication rate was significantly higher in the gastrectomy group. The 3-year survival rate was 94.6 % for ESD and 89.7 % for gastrectomy group (log-rank test, p = 0.44).

Conclusions

ESD achieved similar oncological outcomes when compared with radical gastrectomy for treatment of EGC. Patients receiving ESD had better perioperative outcomes in terms of operative time, complication rate, and hospital stay.

Keywords

Endoscopic submucosal dissection Early gastric cancer Radical gastrectomy 

Notes

Disclosures

Philip Wai Yan Chiu, Anthony Yun Bun Teoh, Ka Fai To, Simon Kin Hung Wong, Shirley Yuk Wah Liu, Candice CH Lam, Man Yee Yung, Francis Ka Leung Chan, James Yun Wong Lau and Enders Kwok Wai Ng have no conflict of interest or financial ties to declare.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Philip Wai Yan Chiu
    • 1
    Email author
  • Anthony Yun Bun Teoh
    • 1
  • Ka Fai To
    • 3
  • Simon Kin Hung Wong
    • 1
  • Shirley Yuk Wah Liu
    • 1
  • Candice C. H. Lam
    • 1
  • Man Yee Yung
    • 1
  • Francis Ka Leung Chan
    • 2
  • James Yun Wong Lau
    • 1
  • Enders Kwok Wai Ng
    • 1
  1. 1.Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong SARChina
  2. 2.Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SARChina
  3. 3.Department of Anatomical and Cellular Pathology, Institute of Digestive DiseaseThe Chinese University of Hong KongHong Kong SARChina

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