Abstract
Background: There have been concerns over the long-term outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (UD EGC). We aimed to compare the long-term outcomes of ESD and surgery for patients with UD EGC. Methods: We searched PubMed, Embase, and Cochrane Library databases through March 2021 to identify studies that compared the long-term outcomes of ESD and surgery for UD EGC meeting expanded criteria for curative resection. The risk of bias was assessed with the Cochrane tool for non-randomized studies. The risk ratio (RR) was estimated using a fixed-effect model. Results: Overall, 1863 patients from five retrospective cohort studies, including 908 patients with propensity score matching (PSM), were eligible for meta-analysis. ESD was associated with inferior overall survival (OS) compared to surgery in the overall cohort (RR 2.11; 95% CI 1.26–3.55) but not in the PSM cohort (RR 1.18; 95% CI 0.60–2.32). In the PSM cohort, ESD had a lower disease-free survival (DFS) (RR 2.49; 95% CI 1.42–4.35) and higher recurrence (RR 12.61; 95% CI 3.43–46.37), gastric recurrence (RR 11.25; 95% CI 3.06–41.40), and extragastric recurrence (RR 4.23; 95% CI 0.47–37.93). Recurrence outcomes were similar between the overall and PSM cohorts. Disease-specific survival was not significantly different between the two groups in both the overall and PSM cohorts. Conclusion: Although OS after curative ESD for UD EGC was not different from that after surgery in the PSM cohort, DFS and recurrence were inferior after ESD. Limitations included a lack of randomized trials. Further prospective studies comparing the long-term outcomes of ESD and surgery for UD EGC are needed (PROSPERO CRD 42021237097).
| Original language | English |
|---|---|
| Pages (from-to) | 3686-3697 |
| Number of pages | 12 |
| Journal | Surgical endoscopy |
| Volume | 36 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 2022 Jun |
Bibliographical note
Funding Information:We thank the authors who kindly provided additional data for this meta-analysis: Young-Il Kim, Center for Gastric Cancer, National Cancer Center, Goyang, Korea; Lijun Peng, Department of Gastroenterology, Linyi People’s Hospital, 11th School of Clinical Medicine of Qingdao University, Linyi, P. R. China; Joo Hyun Lim, Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea; Sang Gyun Kim, Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; Kee Don Choi, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Yong Kang Lee, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea; and Jun Chul Park, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Funding Information:
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Numbers: HI19C0481, HC20C0123).
Publisher Copyright:
© 2022, The Author(s).
All Science Journal Classification (ASJC) codes
- Surgery
