Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer

Abstract

Background: Endoscopic submucosal dissection (ESD) has become a preferred treatment option for early gastric cancer (EGC). This study aimed to compare the clinical outcomes of ESD and surgical resection for EGC. Methods: This was a retrospective case–control study. Patients with a diagnosis of EGC who underwent ESD or surgery in our hospital from 2011 to 2020 were enrolled. We compared the clinical characteristics and treatment outcomes of these two groups according to propensity score-matching. The primary outcome comparison was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related events. Results: In the matched cohort, the ESD group showed comparable OS, RFS, and DSS with the surgery group. Statistical differences were shown in blood loss and adverse events. Furthermore, the ESD group showed lower hospital cost, as well as a shorter operative time and hospital duration than the surgery group. The R0 resection and recurrence rates were similar between the two groups. In Cox regression analysis, age, tumor size, poor differentiation, and lymphovascular invasion were regarded as independent factors of OS. Conclusions: With sufficient safety and advantages, ESD can be a first-line treatment of EGC. Preoperative evaluation is vital to the appropriate treatment and prognosis.

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

“…The results overlap with those stated above for general cohorts, with ESD showing a significantly lower 5-year DFS, no statistical difference in DSS, and similar OS (Table 4). A number of studies have reported on the hospital costs associated with either procedure [69][70][71]. ESD seems to account for significantly lower costs when compared to surgery, which is mostly due to the nature of the procedure itself and differences in the length of stay.…”

“…A number of studies have reported on the hospital costs associated with either procedure [ 69 , 70 , 71 ]. ESD seems to account for significantly lower costs when compared to surgery, which is mostly due to the nature of the procedure itself and differences in the length of stay.…”

Knowledge, attitude, and practice of monitoring early gastric cancer after endoscopic submucosal dissection

“…Endoscopic submucosal dissection (ESD) is considered the first-line treatment for EGC regardless of its size or ulceration[ 4 ]. When compared to gastrectomy, ESD provides faster recovery, lower costs, and superior quality of life for patients with EGC.…”