Surgical Endoscopy

, Volume 32, Issue 1, pp 73–86 | Cite as

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

  • Kyu Yeon Hahn
  • Chan Hyuk Park
  • Yong Kang Lee
  • Hyunsoo Chung
  • Jun Chul Park
  • Sung Kwan Shin
  • Yong Chan Lee
  • Hyoung-Il Kim
  • Jae-Ho Cheong
  • Woo Jin Hyung
  • Sung Hoon Noh
  • Sang Kil Lee



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.


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.


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).


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.


Endoscopic submucosal dissection Absolute indication Expanded indication Undifferentiated histology Outcomes 


Compliance with ethical standards


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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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Kyu Yeon Hahn
    • 1
  • Chan Hyuk Park
    • 2
  • Yong Kang Lee
    • 1
  • Hyunsoo Chung
    • 3
  • Jun Chul Park
    • 1
  • Sung Kwan Shin
    • 1
  • Yong Chan Lee
    • 1
  • Hyoung-Il Kim
    • 4
  • Jae-Ho Cheong
    • 4
  • Woo Jin Hyung
    • 4
  • Sung Hoon Noh
    • 4
  • Sang Kil Lee
    • 1
  1. 1.Department of Internal Medicine, Institute of Gastroenterology, Severance HospitalYonsei University College of MedicineSeoulKorea
  2. 2.Department of Internal Medicine, Guri HospitalHanyang University College of MedicineSeoulKorea
  3. 3.Department of Internal Medicine and Liver Research InstituteSeoul National University of MedicineSeoulKorea
  4. 4.Department of Surgery, Severance HospitalYonsei University College of MedicineSeoulKorea

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