Surgical Endoscopy

, Volume 30, Issue 9, pp 3673–3683 | Cite as

Comparison of endoscopic resection and gastrectomy for the treatment of early gastric cancer: a meta-analysis

  • Fan-Sheng Meng
  • Zhao-Hong Zhang
  • Ya-Mei Wang
  • Lin LuEmail author
  • Jin-Zhou Zhu
  • Feng JiEmail author



Endoscopic resection methods, including endoscopic mucosal resection and endoscopic submucosal dissection, have become standard treatment modalities for patients with early gastric cancer (EGC) and absolute indications, with en bloc resection being more frequent with the latter. Endoscopic resection, however, has been associated with higher recurrence and metachronous cancer rates than gastrectomy. This meta-analysis compared the efficacy and safety of endoscopic resection and gastrectomy for EGC.


PubMed, EMBASE and Web of Science were electronically searched for relevant studies comparing endoscopic resection and gastrectomy for EGC from 1976 through March 2015. The primary endpoints were en bloc resection and histologically complete resection rates. The secondary endpoints were duration of hospital stay and rates of complications, recurrence, metachronous cancer and overall survival.


This meta-analysis enrolled 10 studies with 2070 patients: 993 patients who underwent endoscopic resection and 1077 who underwent gastrectomy. Endoscopic resection was associated with shorter hospital stay (standardized mean difference −2.02; 95 % confidence interval [CI] −2.64 to −1.39) and lower complication rate (relative risk [RR] 0.41; 95 % CI 0.22–0.76) than gastrectomy. However, endoscopic resection was associated with lower rates of en bloc resection (odds ratio [OR] 0.05; 95 % CI 0.02–0.16) and histologically complete resection (OR 0.04; 95 % CI 0.01–0.11) and higher rates of recurrence (RR 5.23; 95 % CI 2.43–11.27) and metachronous cancer (RR 5.22; 95 % CI 2.40–11.34) than gastrectomy. Overall survival rate (OR 1.18; 95 % CI 0.76–1.82) was similar.


Endoscopic resection is minimally invasive and as effective as surgery, suggesting that the former be considered standard treatment for EGC. It should be recommended as standard treatment for EGC with indications. Additional randomized controlled trials from more countries are required.


Early gastric cancer Endoscopic mucosal resection Endoscopic resection Endoscopic submucosal dissection Gastrectomy Surgery 


Compliance with ethical standards


Drs. Fan-Sheng Meng, Zhao-Hong Zhang, Ya-Mei Wang, Lin Lu, Jin-Zhou Zhu and Feng Ji have no conflicts of interest or financial ties to disclose.


  1. 1.
    Japanese Gastric Cancer A (1998) Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer 1:10–24CrossRefGoogle Scholar
  2. 2.
    Mo X, Yang Y, Lai H, Xiao J, He K, Chen J, Lin Y (2014) Does carbon dioxide pneumoperitoneum enhance wound metastases following laparoscopic abdominal tumor surgery? A meta-analysis of 20 randomized control studies. Tumor Biol 35:7351–7359CrossRefGoogle Scholar
  3. 3.
    Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883CrossRefPubMedGoogle Scholar
  4. 4.
    Assoc JGC (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  5. 5.
    Park CH, Shin S, Park JC, Shin SK, Lee SK, Lee YC, Lee H (2013) Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication. Dig Liver Dis 45:651–656CrossRefPubMedGoogle Scholar
  6. 6.
    Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, Choi KS, Kim do H, Song HJ, Lee GH, Kim JH, Park YS (2011) Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 74:485–493CrossRefPubMedGoogle Scholar
  7. 7.
    Lee IS, Yook JH, Park YS, Kim KC, Oh ST, Kim BS (2013) Suitability of endoscopic submucosal dissection for treatment of submucosal gastric cancers. Br J Surg 100:668–673CrossRefPubMedGoogle Scholar
  8. 8.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kim Y, Kim YW, Choi IJ, Cho JY, Kim JH, Kwon JW, Lee JY, Lee NR, Seol SY (2015) Cost comparison between surgical treatments and endoscopic submucosal dissection in patients with early gastric cancer in Korea. Gut Liver 9:174–180CrossRefPubMedGoogle Scholar
  10. 10.
    Fukase K, Oshima S, Hara T, Saito Y, Miura T, Fujishima S, Suzuki Y, Shirahata N, Suzuki K, Takeda H (2012) Comparative evaluation of long-term prognosis between endoscopic treatment and surgery for early gastric cancer. Gastroenterol Endosc 54:1121Google Scholar
  11. 11.
    Zhou P, Peng G, Yang S, Chen D, Li Y, Zhang H, Fang D, Yao L (2014) Effectiveness of endoscopic submucosal dissection vs gastrectomy for early gastric cancer and precancerous lesions. J Third Mil Med Univ 36:1507–1511Google Scholar
  12. 12.
    Zhang HY, Liu HB (2014) Clinical effects of endoscopic submucosal dissection vs surgical treatment for early gastric cancer. World Chin J Digestol 22:5330–5333CrossRefGoogle Scholar
  13. 13.
    Choi ES, Park KS, Cho KB, Kim ES, Lee SM (2014) Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer: a cross-sectional study. J Gastroenterol Hepatol (Australia) 29:4CrossRefGoogle Scholar
  14. 14.
    Park SJ, Ahn JY, Jung HY, Na S, Park SE, Kim MY, Choi KS, Lee JH, Kim do H, Choi KD, Song HJ, Lee GH, Kim JH, Han S (2015) Endoscopic resection for synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma in early stage is a possible alternative to surgery. Gut Liver 9:59–65CrossRefPubMedGoogle Scholar
  15. 15.
    Kim HS, Lee DK, Baik SK, Kim JM, Kwon SO, Kim DS, Cho MY (2000) Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerous lesions: comparison of its therapeutic efficacy with surgical resection. Yonsei Med J 41:577–583CrossRefPubMedGoogle Scholar
  16. 16.
    Etoh T, Katai H, Fukagawa T, Sano T, Oda I, Gotoda T, Yoshimura K, Sasako M (2005) Treatment of early gastric cancer in the elderly patient: results of EMR and gastrectomy at a national referral center in Japan. Gastrointest Endosc 62:868–871CrossRefPubMedGoogle Scholar
  17. 17.
    Chiu PWY, Teoh AYB, To KF, Wong SKH, Liu SYW, Lam CCH, Yung MY, Chan FKL, Lau JYW, Ng EKW (2012) Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc Other Interv Tech 26:3584–3591CrossRefGoogle Scholar
  18. 18.
    Kim DY, Hong SJ, Cho GS, Jeong GA, Kim HK, Han JP, Lee YN, Ko BM, Lee MS (2014) Long-term efficacy of endoscopic submucosal dissection compared with surgery for early gastric cancer: a retrospective cohort study. Gut Liver 8:519–525CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Chung MW, Jeong O, Park YK, Lee KH, Lee JH, Lee WS, Joo YE, Choi SK, Cho SB (2014) Comparison on the long term outcome between endoscopic submucosal dissection and surgical treatment for undifferentiated early gastric cancer. Korean J Gastroenterol = Taehan Sohwagi Hakhoe chi 63:90–98CrossRefPubMedGoogle Scholar
  20. 20.
    Choi IJ, Lee JH, Kim Y-I, Kim CG, Cho S-J, Lee JY, Ryu KW, Nam B-H, Kook M-C, Kim Y-W (2015) Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. Gastrointest Endosc 81:U333–U395CrossRefGoogle Scholar
  21. 21.
    Choi KS, Jung HY, Choi KD, Lee GH, Song HJ, Kimdo H, Lee JH, Kim MY, Kim BS, Oh ST, Yook JH, Jang SJ, Yun SC, Kim SO, Kim JH (2011) EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 73:942–948CrossRefPubMedGoogle Scholar
  22. 22.
    Park CH, Lee H, Kim DW, Chung H, Park JC, Shin SK, Hyung WJ, Lee SK, Lee YC, Noh SH (2014) Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc 80:599–609CrossRefPubMedGoogle Scholar
  23. 23.
    Zhang WJ, Pan WS, Chen GL (2012) Endoscopic therapy versus surgery for treatment of high-grade intraepithelial neoplasia and early gastric cancer: a comparative study of efficacy and economics. J Pract Oncol 27:264–267Google Scholar
  24. 24.
    Yamashina T, Uedo N, Dainaka K, Aoi K, Matsuura N, Ito T, Fujii M, Kanesaka T, Yamamoto S, Akasaka T, Hanaoka N, Takeuchi Y, Higashino K, Ishihara R, Kishi K, Fujiwara Y, Iishi H (2015) Long-term survival after endoscopic resection for early gastric cancer in the remnant stomach: comparison with radical surgery. Ann Gastroenterol 28:66–71PubMedPubMedCentralGoogle Scholar
  25. 25.
    Park YM, Cho E, Kang HY, Kim JM (2011) The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 25:2666–2677CrossRefPubMedGoogle Scholar
  26. 26.
    Cao Y, Liao C, Tan A, Gao Y, Mo Z, Gao F (2009) Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 41:751–757CrossRefPubMedGoogle Scholar
  27. 27.
    Lian J, Chen S, Zhang Y, Qiu F (2012) A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 76:763–770CrossRefPubMedGoogle Scholar
  28. 28.
    Facciorusso A, Antonino M, Di Maso M, Muscatiello N (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: a meta-analysis. World J Gastrointest Endosc 6:555–563CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Holscher AH, Drebber U, Monig SP, Schulte C, Vallbohmer D, Bollschweiler E (2009) Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg 250:791–797CrossRefPubMedGoogle Scholar
  30. 30.
    Lee H, Yun WK, Min BH, Lee JH, Rhee PL, Kim KM, Rhee JC, Kim JJ (2011) A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 25:1985–1993CrossRefPubMedGoogle Scholar
  31. 31.
    Higashimaya M, Oka S, Tanaka S, Sanomura Y, Yoshida S, Hiyama T, Arihiro K, Shimamoto F, Chayama K (2013) Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis. Gastric Cancer 16:404–410CrossRefPubMedGoogle Scholar
  32. 32.
    Abe N, Takeuchi H, Ohki A, Yanagida O, Masaki T, Mori T, Sugiyama M (2011) Long-term outcomes of combination of endoscopic submucosal dissection and laparoscopic lymph node dissection without gastrectomy for early gastric cancer patients who have a potential risk of lymph node metastasis. Gastrointest Endosc 74:792–797CrossRefPubMedGoogle Scholar
  33. 33.
    Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Gastroenterology, The First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
  2. 2.Department of HematologyLinyi People’s HospitalLinyiChina
  3. 3.Department of GastroenterologyLinyi People’s HospitalLinyiChina

Personalised recommendations