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. 2022 Jul 24;14(15):3603.
doi: 10.3390/cancers14153603.

Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer

Meng Qian  1   2 , Yuan Sheng  1 , Min Wu  3 , Song Wang  1 , Kaiguang Zhang  1   2   3
Affiliations

Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer

Meng Qian et al. Cancers (Basel). .

Abstract

Background: Endoscopic submucosal dissection (ESD) has become a preferred treatment option for early gastric cancer (EGC). This study aimed to compare the clinical outcomes of ESD and surgical resection for EGC. Methods: This was a retrospective case-control study. Patients with a diagnosis of EGC who underwent ESD or surgery in our hospital from 2011 to 2020 were enrolled. We compared the clinical characteristics and treatment outcomes of these two groups according to propensity score-matching. The primary outcome comparison was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related events. Results: In the matched cohort, the ESD group showed comparable OS, RFS, and DSS with the surgery group. Statistical differences were shown in blood loss and adverse events. Furthermore, the ESD group showed lower hospital cost, as well as a shorter operative time and hospital duration than the surgery group. The R0 resection and recurrence rates were similar between the two groups. In Cox regression analysis, age, tumor size, poor differentiation, and lymphovascular invasion were regarded as independent factors of OS. Conclusions: With sufficient safety and advantages, ESD can be a first-line treatment of EGC. Preoperative evaluation is vital to the appropriate treatment and prognosis.

Keywords: clinical outcomes; early gastric cancer; endoscopic submucosal dissection; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study population. ESD: endoscopic submucosal dissection.
Figure 2
Figure 2
Kaplan–Meier survival curves of OS, RFS, and DSS in ESD and surgery groups. (a) OS before and after matching; (b) RFS before and after matching; (c) DSS before and after matching. Abbreviations: OS, overall survival; RFS, recurrence-free survival; DSS, disease-specific survival. **: p < 0.001.
See this image and copyright information in PMC

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