Long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated intramucosal gastric cancer regardless of size

作     者：Gil Ho Lee Eunyoung Lee Bumhee Park Jin Roh Sun Gyo Lim Sung Jae Shin Kee Myung Lee Choong-Kyun Noh 

作者机构：Department of GastroenterologyAjou University School of MedicineSuwon 16499South Korea Department of Biomedical InformaticsAjou University School of MedicineSuwon 16499South Korea Department of PathologyAjou University School of MedicineSuwon 16499South Korea 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2022年第28卷第8期

页      面：840-852页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Early gastric cancer Undifferentiated cancer Expanded indication Endoscopic submucosal dissection Surgery 

摘      要：BACKGROUND The clinical outcomes of endoscopic submucosal dissection(ESD)for undifferentiated(UD)intramucosal early gastric cancer(EGC)compared with those of surgery,regardless of lesion size,are not well ***,there is a concern regarding the treatment plan before and after ESD in cases of UD intramucosal EGC within expanded *** To evaluate clinical outcomes of ESD compared with those of surgery in UD intramucosal EGC patients regardless of tumor *** We enrolled patients with UD intramucosal EGC after ESD with complete resection or surgery from January 2005 to August 2020 who met the within or beyond expanded indications with lesion size2 cm(the only non-curative factor).Overall,123 and 562 patients underwent ESD and surgery,*** propensity-score matching,clinical and long-term outcomes,i.e.,recurrencefree survival(RFS)and overall survival(OS),were *** multivariable Cox proportional hazard model with treatment modality and ESD indication was used to evaluate the recurrence *** After matching,119 patients each were finally enrolled in the ESD and surgery *** median length of hospital stay was shorter in the ESD group than surgery group(4.0 vs 9.0 days,P0.001).Four cases of recurrence after ESD were local recurrences,all of which occurred within 1 *** recurrence was seven(5.9%)and two(1.7%)in the ESD and surgery groups,*** difference was observed between the two groups with respect to OS(P=0.948).However,the ESD group had inferior RFS compared with the surgery group(P=0.031).ESD was associated with the risk of recurrence after initial treatment in all enrolled patients(hazard ratio,5.2;95%confidence interval:1.0-25.8,P=0.045).CONCLUSION Although OS was similar between the two groups,surveillance endoscopy was important for the ESD than for the surgery group because RFS was inferior and local recurrence was an issue.