EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes

Abstract

Background: Limited data exist regarding the long-term outcomes of EMR compared with gastrectomy.

Objective: To compare the long-term outcomes after EMR and surgery.

Design: Retrospective analysis with propensity-score matching.

Setting: Tertiary care center.

Patients: This study involved 215 patients with intramucosal gastric cancer completely removed by EMR and 843 patients who underwent curative surgical resection between January 1997 and August 2002. Propensity-score matching yielded 551 matched patients.

Interventions: EMR versus surgery.

Main outcome measurements: Death and recurrence.

Results: In the matched cohort, there were no significant between-group differences in the risk of death (hazard ratio [HR] for the EMR group 1.39; 95% CI, 0.87-2.23) or recurrence (HR 1.18; 95% CI, 0.22-6.35). Although patients who underwent EMR had higher risk of metachronous gastric cancers (HR 6.72; 95% CI, 2.00-22.58), all recurrent or metachronous gastric cancers after EMR were successfully re-treated without affecting overall survival. Although complication rates were similar (odds ratio 0.84; 95% CI, 0.41-1.70), there were no mortalities in the EMR group compared with 2 in the surgery group. The EMR group had a significantly shorter hospital stay (median 8 days, interquartile range [IQR] 6-11 days vs 15 days, IQR 12-19 days; P<.001) and lower cost of care ($2049, IQR $1586-2425 vs $4042, IQR $3458-4959; P<.001).

Limitations: Retrospective, nonrandomized study.

Conclusions: EMR was comparable to surgery in terms of risk of death and recurrence. Because of its lower medical costs and shorter duration of hospital stay, EMR has advantages over surgery.