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Propensity score-matched comparison of short- and long-term outcomes between surgery and endoscopic submucosal dissection (ESD) for intestinal type early gastric cancer (EGC) of the middle and lower third of the stomach: a European tertiary referral center experience

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Abstract

Background

Despite the comparable results between ESD and gastrectomy reported in multiple Asiatic studies, limited data are currently present on the long-term efficacy of ESD for EGC in Western countries. The aim of this study was to compare the short- and long-term outcomes of the endoscopic submucosal dissection and surgery for non-diffuse early gastric cancer treatment in a Western cohort of patients.

Methods

All patients with a diagnosis of intestinal type EGC located in the middle and lower third of the stomach from 2005 to 2015 were enrolled in the study. All patients completed a 5-year follow-up. Patients were divided according to the procedure performed (ESD/subtotal gastrectomy). The two groups were matched for age, gender, ASA score, tumor dimension, and grade of infiltration (mucosa/submucosa).

Results

After matching, 84 patients (42 per group) were included in the analysis. Peri-procedural morbidity rate was 7.1% and no difference was observed between the two groups (4.8% vs 9.5% for ESD and STG groups, respectively; p = 0.3). Similar results in terms of 5-year OS and DFS were observed for ESD and STG (77.7% vs 71.8% ; p = 0.78 and 74.9% vs 72% ; p = 0.7, respectively). At the multivariate analysis, ASA3 score was recognized as the only negative predictor factor for the 5-year OS (OR 6.2; 95% CI 2.2–16.8; p < 0.001). Regarding the DFS, both ASA3 score (OR 4.4; 95% CI 1.7–10.9; p < 0.001) and submucosal infiltration(OR 5.1; 95% CI 1.2–22.4 ; p = 0.02) were identified as independent risk factors for a worse outcome.

Conclusions

Our results confirm the safety and feasibility ESD for EGC treatment in a Western setting. In addition, this is one of the few reports showing comparable results both in terms of short- and long-term outcomes between ESD and surgery for intestinal type ECG treatment in Western countries.

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Funding

No funding was received for this study.

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Author notes

  1. Giuseppe Quero and Claudio Fiorillo contributed equally to this work.

Authors and Affiliations

  1. Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00166, Rome, Italy

    Giuseppe Quero, Claudio Fiorillo, Fabio Longo, Vito Laterza, Fausto Rosa, Caterina Cina, Roberta Menghi, Antonio Pio Tortorelli & Sergio Alfieri

  2. Università Cattolica del Sacro Cuore Di Roma, Rome, Italy

    Giuseppe Quero, Guido Costamagna & Sergio Alfieri

  3. Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

    Federico Barbaro, Silvia Pecere, Lucio Petruzziello & Guido Costamagna

  4. Centre of Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore Di Roma, Rome, Italy

    Federico Barbaro, Silvia Pecere, Lucio Petruzziello & Guido Costamagna

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  1. Giuseppe Quero
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Correspondence to Claudio Fiorillo.

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Drs Giuseppe Quero, Claudio Fiorillo, Fabio Longo, Vito Laterza, Fausto Rosa, Caterina Cina, Roberta Menghi, Antonio Pio Tortorelli, Federico Barbaro, Silvia Pecere, Lucio Petruzziello, Guido Costamagna, and Sergio Alfieri have no conflicts of interest or financial ties to disclose.

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Quero, G., Fiorillo, C., Longo, F. et al. Propensity score-matched comparison of short- and long-term outcomes between surgery and endoscopic submucosal dissection (ESD) for intestinal type early gastric cancer (EGC) of the middle and lower third of the stomach: a European tertiary referral center experience. Surg Endosc 35, 2592–2600 (2021). https://doi.org/10.1007/s00464-020-07677-3

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