Seung Jee Ryu1, Byung-Wook Kim2, Boo Gyeong Kim1, Ji Hee Kim1, Joon Sung Kim1, Jin Il Kim3, Jae-Myung Park4, Jung-Hwan Oh5, Tae Ho Kim6, Jin-Jo Kim7, Seung-Man Park7, Cho Hyun Park8, Kyo Young Song8, Jun Hyun Lee9, Sung Geun Kim10, Dong Jin Kim11, Wook Kim11. 1. Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea. 2. Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea. bleok@dreamwiz.com. 3. Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 4. Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 5. Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 6. Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 7. Department of General Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 8. Department of General Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 9. Department of General Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 10. Department of General Surgery, St. Paul's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 11. Department of General Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
Abstract
BACKGROUND: Endoscopic submucosal dissection (ESD) is an alternative to surgical resection for treating early gastric cancer (EGC). However, there have been limited reports on the long-term outcome of ESD compared to that of surgical resection. The aim of this study was to evaluate the immediate and long-term clinical and oncologic outcomes of ESD compared to surgical resection. METHOD: We retrospectively reviewed data of patients in five centers who were treated with ESD or surgical resection for EGC within expanded criteria for ESD from 2006 to 2008. RESULT: ESD group had significantly shorter procedure times, shorter fasting period, and shorter hospital stay than the surgical resection group. Immediate complications in the surgical resection group were more common compared to those in the ESD group. Five-year cancer recurrence rate of the ESD group was 12.3 % and significantly higher than 2.1 % of the surgical resection group (P = 0.001). Five-year disease-free survival rate of the surgical resection group was 97 %, which was significantly higher than 85 % of the ESD group (P = 0.001). Metachronous lesions were equally found every year during the follow-up period in the ESD group. Five-year overall survival rates were 100 % for both groups. CONCLUSION: ESD might be an acceptable and effective treatment for EGC considering overall survival rates with fewer early complication rates and shorter duration of hospital stay compared to surgical resection. However, intensive and persistent endoscopic surveillance should be performed after ESD for early detection of metachronous lesions.
BACKGROUND: Endoscopic submucosal dissection (ESD) is an alternative to surgical resection for treating early gastric cancer (EGC). However, there have been limited reports on the long-term outcome of ESD compared to that of surgical resection. The aim of this study was to evaluate the immediate and long-term clinical and oncologic outcomes of ESD compared to surgical resection. METHOD: We retrospectively reviewed data of patients in five centers who were treated with ESD or surgical resection for EGC within expanded criteria for ESD from 2006 to 2008. RESULT: ESD group had significantly shorter procedure times, shorter fasting period, and shorter hospital stay than the surgical resection group. Immediate complications in the surgical resection group were more common compared to those in the ESD group. Five-year cancer recurrence rate of the ESD group was 12.3 % and significantly higher than 2.1 % of the surgical resection group (P = 0.001). Five-year disease-free survival rate of the surgical resection group was 97 %, which was significantly higher than 85 % of the ESD group (P = 0.001). Metachronous lesions were equally found every year during the follow-up period in the ESD group. Five-year overall survival rates were 100 % for both groups. CONCLUSION: ESD might be an acceptable and effective treatment for EGC considering overall survival rates with fewer early complication rates and shorter duration of hospital stay compared to surgical resection. However, intensive and persistent endoscopic surveillance should be performed after ESD for early detection of metachronous lesions.
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