Journal
JOURNAL OF GASTROINTESTINAL SURGERY
Volume 23, Issue 7, Pages 1493-1501Publisher
SPRINGER
DOI: 10.1007/s11605-019-04227-8
Keywords
Early gastric cancer; Endoscopic submucosal dissection; Surgery; Prognosis; Meta-analysis
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BackgroundEndoscopic submucosal dissection (ESD) is an endoscopic alternative to surgical resection of early gastric cancer (EGC). Besides offering both diagnostic and therapeutic capability, it has the benefits of reducing post-operative complications and provides fast recovery and better quality of life compared to surgical resection of neoplastic lesions. However, due to limitations of the procedure, its long-term outcomes are rather controversial.MethodsThis study has been carried out to investigate the long-term outcomes of ESD which includes the overall survival (OS), disease-free survival (DFS), and recurrence rate. The following databases were used to search for articles published until February 2018: Medline, Cochrane Library, PubMed, Web of Science, and EBSCO.ResultsA total of 13 eligible studies covering 4986 patients were selected for a meta-analysis based on specified inclusion and exclusion criteria. The difference of OS and disease-specific survival (DSS) between ESD and surgical treatment was not statistically significant (RR=0.90, 95% CI=0.68-1.19, p=0.46; RR=0.40, 95% CI=0.15-1.03, p=0.06, respectively). However, DFS in the ESD group was much lower than that in the surgery group (RR=3.40, 95% CI=2.39-4.84, p<0.001). In terms of the treatment after recurrence, the proportion of patients who could receive radical treatment was significantly higher in the ESD than that in the gastrectomy (OR=5.27, 95% CI=2.35-11.79, p<0.001).ConclusionsThis meta-analysis showed that ESD might be an alternative treatment option to surgery for patients with EGC in Asian countries. But a close surveillance program after ESD is of necessity, considering the higher possibility of tumor recurrence after ESD.
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