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. 2019 Aug 7:9:725.
doi: 10.3389/fonc.2019.00725. eCollection 2019.

Long-Term Outcomes Comparison of Endoscopic Resection With Gastrectomy for Treatment of Early Gastric Cancer: A Systematic Review and Meta-Analysis

Liangliang An  1 , Sharen Gaowa  2 , Haidong Cheng  1 , Mingxing Hou  1
Affiliations

Long-Term Outcomes Comparison of Endoscopic Resection With Gastrectomy for Treatment of Early Gastric Cancer: A Systematic Review and Meta-Analysis

Liangliang An et al. Front Oncol. .

Abstract

Background: Endoscopic resection (ER) and gastrectomy have been both accepted as curative treatments for early gastric cancer. We intended to compare ER with gastrectomy treatments on safety of patients, disease-free survival and overall survival for early gastric cancer through this systematic review. Methods: A literature search was performed in Pubmed, Embase, and Cochrane Library databases. Studies that have compared ER with gastrectomy for early gastric cancer were included in this meta-analysis. We searched for clinical studies published before March 2019. Stata 12.0 software was used for systematic analysis. Results: Nine studies were included in this systematic review, ER treatment was associated with a shorter length of stay (WMD = -8.53, 95% CI -11.56 to -5.49), fewer postoperative complications (OR = 0.47, 95% CI 0.34-0.65). ER can be performed safely with shorter hospital stay and fewer postoperative complications than gastrectomy. Recurrence rate was higher for ER than for gastrectomy treatment (HR = 3.56, 95% CI 1.86-6.84), mainly because metachronous gastric cancers developed only in the ER treatment. However, most of the metachronous gastric cancers could be curatively treated with ER again, and it didn't affect overall survival of patients with early gastric cancer. There was no difference in overall survival rate between ER and gastrectomy (HR = 0.84, 95% CI 0.63-1.13). Conclusions: ER and gastrectomy are both acceptable for curative treatment of early gastric cancer. However, due to the comparable overall survival and lower postoperative complications and shorter length of stay, ER is better than gastrectomy for early gastric cancer, who met the indication for ER treatment.

Keywords: endoscopic resection; gastrectomy; overall survival; recurrence; systematic review.

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Figures

Figure 1
Figure 1
Flow chart for article screening.
Figure 2
Figure 2
Meta-analysis on length of stay, there was significant difference in length of stay between the ER and gastrectomy treatments.
Figure 3
Figure 3
Subgroup meta-analysis of indication for ER treatment.
Figure 4
Figure 4
Subgroup meta-analysis of ER procedure.
Figure 5
Figure 5
Meta-analysis on postoperative complication, postoperative complications of gastrectomy treatment were higher than that of ER treatment.
Figure 6
Figure 6
Meta-analysis on disease-free survival, patients who underwent ER treatment had higher recurrence rate than that of gastrectomy treatment.
Figure 7
Figure 7
Meta-analysis on overall survival, overall survival did not differ between ER and gastrectomy treatments.
Figure 8
Figure 8
Funnel plot depicting standard error by log relative risk.
Figure 9
Figure 9
Sensitivity analysis of overall survival.
See this image and copyright information in PMC

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