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Endoscopy 2015; 47(04): 293-302
DOI: 10.1055/s-0034-1391284
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Long-term survival after endoscopic resection versus surgery in early gastric cancers

Young-Il Kim   *
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Young-Woo Kim   *
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Il Ju Choi
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Chan Gyoo Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Jong Yeul Lee
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Soo-Jeong Cho
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Bang Wool Eom
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Hong Man Yoon
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Keun Won Ryu
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
,
Myeong-Cheorl Kook
Center for Gastric Cancer, National Cancer Center, Goyang, Korea
› Author Affiliations
Further Information

Publication History

submitted21 April 2014

accepted after revision27 October 2014

Publication Date:
27 January 2015 (online)

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Commentaire du travail de Kim YI et al., pp. 293Endoscopy 2015; 47(04): 391-391
DOI: 10.1055/s-0035-1547028

Background and study aim: Endoscopic resection for early gastric cancers that meet the expanded indication is considered to be an investigational treatment. The study aim was to evaluate long-term outcomes of endoscopic resection compared with surgery for early gastric cancers meeting the expanded indication.

Methods: We retrospectively reviewed data from patients who underwent endoscopic resection or surgery for gastric cancers meeting the expanded indication between 2001 and 2009. Overall survival rate was the primary outcome; gastric cancer recurrence rates and complication rates were secondary outcomes.

Results: Among 457 patients included, 165 underwent endoscopic resection and 292 surgery, with median follow-up duration of 58.6 months. The 5-year overall survival rates were 97.5 % and 97.0 % for endoscopic resection and surgery, respectively; Kaplan–Meier analysis showed no significant difference (P = 0.425). The 5-year gastric cancer recurrence rate was higher for endoscopic resection than for surgery (4.8 % vs. 0.3 %; P < 0.001) mainly because of metachronous cancers which developed only in the endoscopic resection group (9/165, 5.5 %). Most of the metachronous cancers (88.9 %) were curatively treated with endoscopic resection. Early complication rates were similar between the groups (P = 0.557), but the endoscopic resection group had more grade III or higher complications according to the Clavien–Dindo classification compared with the surgery group (4.8 % vs. 1.4 %, P = 0.026). Late complications occurred only following surgery (4.8 %, P = 0.004), and most (92.9 %) were grade III or higher.

Conclusions: Endoscopic resection may be an optimal alternative to surgery for gastric cancers that meet the expanded indication criteria, because of a comparable long-term overall survival rate.

* These two authors contributed equally to this work.


Tables e2 and e3

 

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