Endoscopic Submucosal Dissection versus Surgery for Undifferentiated-Type Early Gastric Cancer: A Systematic Review and Meta-Analysis

Huh, Cheal-Wung; Won, Dae; Kim, Byung-Wook; Kim, Joon Sung; Lee, Seung Jae

doi:10.5946/ce.2020.121

Cited by 16 publications

(11 citation statements)

References 36 publications

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“…In our review, we found that ESD may be as effective as surgery, with similar adjusted all-cause mortality. Our results are consistent with a previous meta-analysis which concluded that ESD has a similar all-cause mortality as gastrectomy in uEGC (28). However, our review has a different methodology, as we excluded patients outside the of expanded criteria.…”

Section: What Is Known In the Literature About The Research Questionsupporting

confidence: 91%

Endoscopic submucosal dissection versus surgery for patients with undifferentiated early gastric cancer

et al. 2022

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Background and aims: endoscopic submucosal dissection (ESD) is the standard treatment for differentiated early gastric cancer (EGC). However, its expanded indication for undifferentiated EGC is controversial. In this study, the efficacy and safety of ESD versus surgery in patients with undifferentiated EGC were compared.Methods: four databases were searched until February 24, 2022, for studies assessing patients with undifferentiated EGC that met an expanded indication for endoscopic resection and who were treated with ESD or surgery. Primary outcomes were all-cause mortality and any recurrence. Secondary outcomes were complete histological resection, local recurrence, metachronous recurrence, synchronous recurrence, distant metastasis, overall complication, and bleeding. All meta-analyses were performed using a random-effects models. Unadjusted (risk ratio [RR]) and adjusted (aRR and hazard ratio [aHR]) estimates with 95 % confidence interval (CI) were calculated.Results: seven cohort studies were included (n = 2637). The use of ESD was significantly associated with higher all-cause mortality compared to surgery (RR, 2.17; 95 % CI, 1.24-3.81); adjusted all-cause mortality effects were not significant (aRR, 2.28; 95 % CI, 1.97; 95 % CI,. ESD was associated with a higher risk of any recurrence using unadjusted (RR, 5.24; 95 % CI, 7.89; 95 % CI, 3.73; 95 % CI, estimates. The risk of local recurrence, synchronous recurrence and bleeding were significantly higher for ESD versus surgery. No significant differences were found for other secondary outcomes.Conclusions: although ESD is associated with a higher risk of any recurrence, adjusted all-cause mortality is similar during follow-up. Overall complications were similar between ESD and surgery.

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Section: What Is Known In the Literature About The Research Questionsupporting

confidence: 91%

Endoscopic submucosal dissection versus surgery for patients with undifferentiated early gastric cancer

et al. 2022

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“…In this guideline, we reviewed papers published after the previous edition. To date, there has been no prospective RCT comparing the long-term OS of endoscopic resection with that of gastrectomy with LN dissection, the standard treatment for these indications [ 169 ]. According to retrospective studies, there was no difference between gastrectomy and endoscopic resection in terms of OS, but endoscopic resection had a higher local recurrence rate in terms of recurrence-free survival (RFS), which is consistent with the findings of previous studies [ 144 170 171 ].…”

Section: Endoscopic Treatment ( Flowchart 2 )mentioning

confidence: 99%

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

et al. 2023

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Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

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“…No significant difference was found in the overall survival rate between the ESD and surgery groups (odds ratio [OR]: 2.29, 95% CI: 0.98–5.36). Nevertheless, ESD was associated with a higher recurrence rate and a lower complete resection rate 22 …”

Section: Endoscopy Versus Surgery For Early Gastric Cancer Treatmentmentioning

confidence: 94%

“…Nevertheless, ESD was associated with a higher recurrence rate and a lower complete resection rate. 22…”

Section: Endoscopy Versus Surgery For Early Gastric Cancer Treatmentmentioning

confidence: 99%

The future of endoscopic resection for early gastric cancer

Ortigão

Libânio

Dinis-Ribeiro

2022

Journal of Surgical Oncology

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Endoscopic resection for early gastric cancer is recommended when the risk of lymph node metastasis is negligible and should be performed through submucosal dissection due to well‐established short‐ and long‐term results. To overcome technical difficulties and decrease adverse events some techniques have been studied. This review outlines current strategies for improving patient selection and highlights innovative techniques that help minimize adverse events. Moreover, we discuss how to improve management after curative and noncurative resections.

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Endoscopic Submucosal Dissection versus Surgery for Undifferentiated-Type Early Gastric Cancer: A Systematic Review and Meta-Analysis

Cited by 16 publications

References 36 publications

Endoscopic submucosal dissection versus surgery for patients with undifferentiated early gastric cancer

Endoscopic submucosal dissection versus surgery for patients with undifferentiated early gastric cancer

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

The future of endoscopic resection for early gastric cancer

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