Prospective comparative study of endoscopic submucosal dissection and gastrectomy for early neoplastic lesions including patients’ perspectives

Abstract

Background There are no prospective studies comparing endoscopic submucosal dissection (ESD) and gastrectomy, especially evaluating patient-reported outcomes. Our aim was to compare the safety and impact on quality of life (QoL) of ESD and gastrectomy in patients with early gastric neoplasia.

Methods This prospective study included consecutive patients presenting with early gastric neoplasia in a tertiary center from January 2015 to August 2016. Data collection included curative resection, adverse events (AEs), and patient-reported outcomes (questionnaires: EORTC QLQ-C30, EORTC STO-22, EQ-5D-5 L, and Assessment of Survivor Concerns) before and after interventions (after 1 month, 3 – 6 months, and 1 year).

Results 254 patients with early lesions were included: 153 managed by ESD and 101 by gastrectomy, the former being significantly older and with less advanced lesions. Mean procedural time and length of stay were significantly higher in the surgery group (164 vs. 72 minutes and 16.3 vs. 3.5 days; P < 0.001). Complete resection was higher in the surgical group (99 % vs. 90 %; P = 0.02); ESD was curative in 79 % of patients. Severe AEs and surgical re-intervention were significantly more frequent in the gastrectomy group (21.8 % vs. 7.8 % and 11 % vs. 1 %, respectively). Endoscopic treatment was associated with a positive impact on global health-related QoL at 1 year (net difference + 9.9; P = 0.006), role function and symptom scales (fatigue, pain, appetite, eating restrictions, dysphagia, and body image). Concerns about recurrence did not differ between the groups.

Conclusions In patients with early gastric neoplasia, ESD is safer and is associated with a positive impact on health-related QoL when compared with gastrectomy, without increasing fear of recurrence and new lesions.

• References

• 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
• 2 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
• 3 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014. (ver. 4) Gastric Cancer 2017; 20: 1-19
• 4 Smyth EC, Verheij M, Allum W. et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27: v38-v49
• 5 Ajani JA, D'Amico TA, Almhanna K. et al. Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2016; 14: 1286-1312
• 6 Tanabe S, Ishido K, Matsumoto T. et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a multicenter collaborative study. Gastric Cancer 2017; 20: 45-52
• 7 Jeon HK, Kim GH, Lee BE. et al. Long-term outcome of endoscopic submucosal dissection is comparable to that of surgery for early gastric cancer: a propensity-matched analysis. Gastric Cancer 2018; 21: 133-143
• 8 Kim DY, Hong SJ, Cho GS. et al. Long-term efficacy of endoscopic submucosal dissection compared with surgery for early gastric cancer: a retrospective cohort study. Gut Liver 2014; 8: 519-525
• 9 Ryu SJ, Kim BW, Kim BG. et al. Endoscopic submucosal dissection versus surgical resection for early gastric cancer: a retrospective multicenter study on immediate and long-term outcome over 5 years. Surg Endosc 2016; 30: 5283-5289
• 10 Shin DW, Hwang HY, Jeon SW. Comparison of endoscopic submucosal dissection and surgery for differentiated type early gastric cancer within the expanded criteria. Clin Endosc 2017; 50: 170-178
• 11 Chiu PW, Teoh AY, To KF. et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 2012; 26: 3584-3591
• 12 Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg 2009; 250: 177-186
• 13 Aaronson NK, Ahmedzai S, Bergman B. et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376
• 14 Vickery CW, Blazeby JM, Conroy T. et al. Development of an EORTC disease-specific quality of life module for use in patients with gastric cancer. Eur J Cancer 2001; 37: 966-971
• 15 Pickard AS, De Leon MC, Kohlmann T. et al. Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med Care 2007; 45: 259-263
• 16 Gotay CC, Pagano IS. Assessment of Survivor Concerns (ASC): a newly proposed brief questionnaire. Health Qual Life Outcomes 2007; 5: 15
• 17 Lee SS, Chung HY, Kwon OK. et al. Quality of life in cancer survivors 5 years or more after total gastrectomy: a case-control study. Int J Surg 2014; 12: 700-705
• 18 Lee SS, Chung HY, Kwon O. et al. Long-term shifting patterns in quality of life after distal subtotal gastrectomy: preoperative- and healthy-based interpretations. Ann Surg 2015; 261: 1131-1137
• 19 Yu W, Park KB, Chung HY. et al. Chronological changes of quality of life in long-term survivors after gastrectomy for gastric cancer. Cancer Res Treat 2016; 48: 1030-1036
• 20 Pimentel-Nunes P, Mourao F, Veloso N. et al. Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal. Endoscopy 2014; 46: 933-940
• 21 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M. et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009; 69: 350-355
• 22 Libanio D, Pimentel-Nunes P, Afonso LP. et al. Long-term outcomes of gastric endoscopic submucosal dissection: focus on metachronous and non-curative resection management. GE Port J Gastroenterol 2017; 24: 31-39
• 23 Choi JH, Kim ES, Lee YJ. et al. Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer. Gastrointest Endosc 2015; 82: 299-307