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Meta-Analysis
. 2015 Oct;94(43):e1649.
doi: 10.1097/MD.0000000000001649.

Endoscopic Resection Versus Surgical Resection for Early Gastric Cancer: A Systematic Review and Meta-Analysis

Weili Sun  1 , Xiao Han, Siyuan Wu, Chuanhua Yang
Affiliations
Meta-Analysis

Endoscopic Resection Versus Surgical Resection for Early Gastric Cancer: A Systematic Review and Meta-Analysis

Weili Sun et al. Medicine (Baltimore). 2015 Oct.

Abstract

Endoscopic resection (ER) has been widely accepted to treat early gastric cancer (EGC) in place of surgical resection (SR). The aim of this meta-analysis was to conduct a comprehensive comparison between the two methods.Four literature databases, including PubMed, Web of Science, the Cochrane Library, and EMBASE, were searched for studies that compared ER with SR to treat EGC. In this meta-analysis, primary and secondary endpoints were compared between the two groups. Primary endpoints included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and recurrence-free survival (RFS). Secondary endpoints included operation-related death, local recurrence, metachronous lesions, procedure-related complication, bleeding, hospital stay, operation time, and cost.Nineteen studies consisting of a total of 6118 patients were identified and selected for evaluation. Meta-analysis showed that long-term outcomes of ER versus SR for EGC were comparable in terms of 5-year OS (risk ratio [RR] 1.00, 95% confidence interval [CI] 0.98-1.02), DSS (RR 0.98, 95% CI 0.89-1.08), DFS (RR 0.95, 95% CI 0.86-1.05), and RFS (RR 0.98, 95% CI 0.94-1.01). However, ER had shorter operation time (standardized mean difference [SMD] -3.39, 95% CI -3.58 to 3.20), hospital stay (SMD -2.86, 95% CI -4.02 to -1.69), lower costs (SMD -5.30, 95% CI -10.37 to -0.22), and fewer procedure-related complications (RR 0.43, 95% CI 0.28-0.65) compared to SR. Nevertheless, ER had higher incidences of local recurrence (risk difference 0.01, 95% CI 0.00-0.02) and metachronous lesions (RR 6.81, 95% CI 3.80-12.19).Endoscopic resection was associated with similar long-term outcomes and considerable advantages concerning operation time, hospital stay, costs, and complications, compared with SR, and was also associated with disadvantages such as higher incidence of local recurrence and metachronous lesions. Further high-quality studies from more countries are required to confirm these results.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow chart for article screening. EGC = early gastric cancer, ER = endoscopic resection, SR = surgical resection.
FIGURE 2
FIGURE 2
Forest plots of 3-year overall survival rate (A), 5-year overall survival rate (B), 10-year overall survival rate (C). CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 3
FIGURE 3
Forest plots of 3-year disease-specific survival rate (A), 5-year disease-specific survival rate (B). CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 4
FIGURE 4
Forest plots of 3-year disease-free survival rate (A), 5-year disease-free survival rate (B). CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 5
FIGURE 5
Forest plots of 3-year recurrence-free survival rate (A), 5-year recurrence-free survival rate (B) and 10-year recurrence-free survival rate (C). CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 6
FIGURE 6
Forest plots of procedure-related complication. CI, confidence interval; df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 7
FIGURE 7
Forest plots of procedure-related bleeding. CI = confidence interval = df, degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 8
FIGURE 8
Forest plots of operation-related death. CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 9
FIGURE 9
Forest plots of local recurrence rate. CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 10
FIGURE 10
Forest plots of metachronous lesions. CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SR = surgical resection.
FIGURE 11
FIGURE 11
Forest plots of hospital stay. CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SD = standard deviation, SR = surgical resection.
FIGURE 12
FIGURE 12
Forest plots of operation time. CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SD = standard deviation, SR = surgical resection.
FIGURE 13
FIGURE 13
Forest plots of cost. CI = confidence interval, df = degrees of freedom, ER = endoscopic resection, M-H = Mantel-Haenszel, SD = standard deviation, SR = surgical resection.
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