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. 2023 Sep 26;23(1):292.
doi: 10.1186/s12893-023-02194-1.

Comparison of clinical outcomes and prognosis between surgery and endoscopic submucosal dissection in patients with synchronous multifocal early gastric cancer

Linsen Bao #  1   2 , Hengfei Gao #  1   2 , Lingxiao Pu #  1   2 , Chao Sui  1   2 , Kangkang Ji  2 , Feng Wang  1 , Liang Tao  3   4 , Min Feng  5   6 , Meng Wang  7   8
Affiliations

Comparison of clinical outcomes and prognosis between surgery and endoscopic submucosal dissection in patients with synchronous multifocal early gastric cancer

Linsen Bao et al. BMC Surg. .

Abstract

Background: Synchronous multiple early gastric cancer (SMEGC) refers to the simultaneous occurrence of two or more malignant cancer lesions in the stomach. For patients with multiple early gastric carcinomas, the choice of appropriate treatment remains controversial. This study is dedicated to comparing the clinical outcomes and prognosis of patients with SMEGC who underwent endoscopic submucosal dissection (ESD) or gastrectomy.

Methods: A total of 180 patients with more than one malignant cancer lesion in the stomach who had received gastrectomy or ESD between 2012 and 2021 were retrospectively evaluated to determine their clinical outcomes and prognosis. Univariate and multivariate logistic regression were utilized to identify risk factors for tumor recurrence.

Results: Over the 57.5 months median follow-up period for the 140 enrolled cases, tumor recurrence occurred in 8 (12%) in the ESD group but only 1 (1%) in the surgery group. Relapse-free survival (RFS) was higher in the surgery group (p = 0.023) in all cases; however, there was no significant difference in Overall survival (OS, p = 0.772). Complications were significantly higher in the surgery group than in the ESD group, but fewer in the radical distal gastrectomy group. Multivariate regression analysis revealed that ESD(p = 0.034), the main lesion size > 2 cm(p = 0.019), and undifferentiated tumor(p = 0.022) were independent risk factors for tumor recurrence.

Conclusions: For the treatment of simultaneous multifocal early gastric cancer, ESD has a good short-term effect and higher quality of life. However, ESD has a higher risk of recurrence than surgery. And we found that the partial gastrectomy appears to be considered as adequate treatment for some SMEGC patients.

Keywords: Endoscopic submucosal dissection; Prognosis; Surgical treatment; Synchronous multiple neoplasms.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection of multiple synchronous early gastric cancers treated by ESD and surgery
Fig. 2
Fig. 2
Correlation of tumor size in main and minor lesions of multiple synchronous early gastric cancers
Fig. 3
Fig. 3
Kaplan–Meier curve comparisons of overall survival (OS) and relapse free survival (RFS) in the ESD group(n = 67) and surgery group(n = 73), (A) OS; (B) RFS, ESD endoscopic submucosal dissection
Fig. 4
Fig. 4
Kaplan–Meier curve comparisons of overall survival (OS) in the partial gastrectomy group (n = 30) and the total gastrectomy group (n = 43)
See this image and copyright information in PMC

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