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Journal of Gastrointestinal Surgery

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01-07-2019 | Gastrectomy | Review Article

Comparison of Long-Term Outcomes of Endoscopic Submucosal Dissection and Surgery for Early Gastric Cancer: a Systematic Review and Meta-analysis

Authors: Lihu Gu, Parikshit A. Khadaroo, Liangliang Chen, Xinlong Li, Hepan Zhu, Xin Zhong, Junhai Pan, Manman Chen

Published in: Journal of Gastrointestinal Surgery | Issue 7/2019

Abstract

Background

Endoscopic submucosal dissection (ESD) is an endoscopic alternative to surgical resection of early gastric cancer (EGC). Besides offering both diagnostic and therapeutic capability, it has the benefits of reducing post-operative complications and provides fast recovery and better quality of life compared to surgical resection of neoplastic lesions. However, due to limitations of the procedure, its long-term outcomes are rather controversial.

Methods

This study has been carried out to investigate the long-term outcomes of ESD which includes the overall survival (OS), disease-free survival (DFS), and recurrence rate. The following databases were used to search for articles published until February 2018: Medline, Cochrane Library, PubMed, Web of Science, and EBSCO.

Results

A total of 13 eligible studies covering 4986 patients were selected for a meta-analysis based on specified inclusion and exclusion criteria. The difference of OS and disease-specific survival (DSS) between ESD and surgical treatment was not statistically significant (RR = 0.90, 95% CI = 0.68–1.19, p = 0.46; RR = 0.40, 95% CI = 0.15–1.03, p = 0.06, respectively). However, DFS in the ESD group was much lower than that in the surgery group (RR = 3.40, 95% CI = 2.39–4.84, p < 0.001). In terms of the treatment after recurrence, the proportion of patients who could receive radical treatment was significantly higher in the ESD than that in the gastrectomy (OR = 5.27, 95% CI = 2.35–11.79, p < 0.001).

Conclusions

This meta-analysis showed that ESD might be an alternative treatment option to surgery for patients with EGC in Asian countries. But a close surveillance program after ESD is of necessity, considering the higher possibility of tumor recurrence after ESD.

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Goto O, Shimoda M, Sasaki M, Kiguchi Y, Mitsunaga Y, Akimoto T, Ochiai Y, Fujimoto A, Maehata T, Nishizawa T, Takeuchi H, Kitagawa Y, Kameyama K, Yahagi N. Potential for peritoneal cancer cell seeding in endoscopic full-thickness resection for early gastric cancer. Gastrointest Endosc 2018; 87: 450–456. https://doi.org/10.1016/j.gie.2017.08.036 CrossRefPubMed

Jung DH, Lee Y, Kim DW, Park YS, Ahn SH, Park DJ, Kim HH. Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer. Surg Endosc 2017; 31: 3961–3969. https://doi.org/10.1007/s00464-017-5429-9 CrossRefPubMed

Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakamura T, Nakaya N, Shimosegawa T. Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study. Gastric Cancer 2017. https://doi.org/10.1007/s10120-017-0769-7

Tanabe S, Ishido K, Matsumoto T, Kosaka T, Oda I, Suzuki H, Fujisaki J, Ono H, Kawata N, Oyama T, Takahashi A, Doyama H, Kobayashi M, Uedo N, Hamada K, Toyonaga T, Kawara F, Tanaka S, Yoshifuku Y. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a multicenter collaborative study. Gastric Cancer 2017; 20: 45–52. https://doi.org/10.1007/s10120-016-0664-7 CrossRefPubMed

Sumiyoshi T, Kondo H, Fujii R, Minagawa T, Fujie S, Kimura T, Ihara H, Yoshizaki N, Hirayama M, Oyamada Y, Okushiba S. Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older. Gastric Cancer 2017; 20: 489–495. https://doi.org/10.1007/s10120-016-0628-y CrossRefPubMed

Kim SG, Ji SM, Lee NR, Park SH, You JH, Choi IJ, Lee WS, Park SJ, Lee JH, Seol SY, Kim JH, Lim CH, Cho JY, Kim GH, Chun HJ, Lee YC, Jung HY, Kim JJ. Quality of Life after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Multicenter Cohort Study. Gut Liver 2017; 11: 87–92. https://doi.org/10.5009/gnl15549 CrossRefPubMed

Hasuike N, Ono H, Boku N, Mizusawa J, Takizawa K, Fukuda H, Oda I, Doyama H, Kaneko K, Hori S, Iishi H, Kurokawa Y, Muto M. A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer 2018; 21: 114–123. https://doi.org/10.1007/s10120-017-0704-y CrossRefPubMed

Kim JH, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, Kim H, Hyung WJ, Noh SH, Kim CB, Chung JB. Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc 2009; 69: e1–9. https://doi.org/10.1016/j.gie.2008.10.040 CrossRefPubMed

Nakamoto S, Sakai Y, Kasanuki J, Kondo F, Ooka Y, Kato K, Arai M, Suzuki T, Matsumura T, Bekku D, Ito K, Tanaka T, Yokosuka O. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection. Endoscopy 2009; 41: 746–750. https://doi.org/10.1055/s-0029-1215010 CrossRefPubMed

10.

Hahn KY, Park CH, Lee YK, Chung H, Park JC, Shin SK, Lee YC, Kim HI, Cheong JH, Hyung WJ, Noh SH, Lee SK. Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer. Surg Endosc 2018; 32: 73–86. https://doi.org/10.1007/s00464-017-5640-8 CrossRefPubMed

11.

Fujiya K, Takizawa K, Tokunaga M, Kawata N, Hikage M, Makuuchi R, Tanizawa Y, Bando E, Kawamura T, Tanaka M, Kakushima N, Ono H, Terashima M. The value of diagnostic endoscopic submucosal dissection for patients with clinical submucosal invasive early gastric cancer. 2018; 21: 124–132. https://doi.org/10.1007/s10120-017-0724-7 CrossRefPubMed

12.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8: 336–341. https://doi.org/10.1016/j.ijsu.2010.02.007 CrossRefPubMed

13.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1. https://doi.org/10.1186/2046-4053-4-1 CrossRefPubMedPubMedCentral

14.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603–605. https://doi.org/10.1007/s10654-010-9491-z CrossRefPubMed

15.

Jeon HK, Kim GH, Lee BE, Park DY, Song GA, Kim DH, Jeon TY. 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. https://doi.org/10.1007/s10120-017-0719-4 CrossRefPubMed

16.

Ioannidis JP, Trikalinos TA. The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey. Cmaj 2007; 176: 1091–1096. https://doi.org/10.1503/cmaj.060410 CrossRefPubMedPubMedCentral

17.

Chang JY, Shim KN, Tae CH, Lee KE, Lee J, Lee KH, Moon CM, Kim SE, Jung HK, Jung SA, Lee JH, Cho MS. Comparison of clinical outcomes after endoscopic submucosal dissection and surgery in the treatment of early gastric cancer: A single-institute study. Medicine (Baltimore) 2017; 96: e7210. https://doi.org/10.1097/md.0000000000007210 CrossRef

18.

Gong EJ, Kim DH, Ahn JY, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY, Kim HS, Lee IS, Kim BS, Yoo MW, Oh ST, Yook JH, Kim BS. Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for esophagogastric junction adenocarcinoma. Gastric Cancer 2017; 20: 84–91. https://doi.org/10.1007/s10120-016-0679-0 CrossRefPubMed

19.

Park JC, Lee YK, Kim SY, Roh Y, Hahn KY, Shin SK, Lee SK, Lee YC, Kim HI, Cheong JH, Hyung WJ, Noh SH. Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis. Surg Endosc 2018; 32: 2046–2057. https://doi.org/10.1007/s00464-017-5901-6 CrossRefPubMed

20.

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. https://doi.org/10.5946/ce.2016.017 CrossRefPubMed

21.

Park CH, Lee H, Kim DW, Chung H, Park JC, Shin SK, Hyung WJ, Lee SK, Lee YC, Noh SH. Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc 2014; 80: 599–609. https://doi.org/10.1016/j.gie.2014.04.042 CrossRefPubMed

22.

Kim DY, Hong SJ, Cho GS, Jeong GA, Kim HK, Han JP, Lee YN, Ko BM, Lee MS. Long-term efficacy of endoscopic submucosal dissection compared with surgery for early gastric cancer: a retrospective cohort study. Gut Liver 2014; 8: 519–525. https://doi.org/10.5009/gnl13061 CrossRefPubMedPubMedCentral

23.

Cho JH, Cha SW, Kim HG, Lee TH, Cho JY, Ko WJ, Jin SY, Park S. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a comparison study to surgery using propensity score-matched analysis. Surg Endosc 2016; 30: 3762–3773. https://doi.org/10.1007/s00464-015-4672-1 CrossRefPubMed

24.

Kim HJ, Chung H, Shin SK, Kim HI, Park JC, Lee SK, Hyung WJ, Lee YC, Noh SH. Comparison of long-term clinical outcomes between endoscopic and surgical resection for early-stage adenocarcinoma of the esophagogastric junction. Surg Endosc 2018. https://doi.org/10.1007/s00464-018-6076-5

25.

Fukunaga S, Nagami Y, Shiba M, Ominami M, Tanigawa T, Yamagami H, Tanaka H, Muguruma K, Watanabe T, Tominaga K, Fujiwara Y, Ohira M, Hirakawa K, Arakawa T. Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis. Gastrointest Endosc 2017; 85: 143–152. https://doi.org/10.1016/j.gie.2016.06.049 CrossRefPubMed

26.

Ryu SJ, Kim BW, Kim BG, Kim JH, Kim JS, Kim JI, Park JM, Oh JH, Kim TH, Kim JJ, Park SM, Park CH, Song KY, Lee JH, Kim SG, Kim DJ, Kim W. 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. https://doi.org/10.1007/s00464-016-4877-y CrossRefPubMed

27.

Lee S, Choi KD, Han M, Na HK, Ahn JY, Jung KW, Lee JH, Kim DH, Song HJ, Lee GH, Yook JH, Kim BS, Jung HY. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors: a criteria-based analysis. Gastric Cancer 2017. https://doi.org/10.1007/s10120-017-0772-z

28.

Nagahama T, Yao K, Uedo N, Doyama H, Ueo T, Uchita K, Ishikawa H, Kanesaka T, Takeda Y, Wada K, Imamura K, Arima H, Shimokawa T. Delineation of the extent of early gastric cancer by magnifying narrow-band imaging and chromoendoscopy: a multicenter randomized controlled trial. Endoscopy 2018. https://doi.org/10.1055/s-0044-100790

29.

Kim YI, Kim YA, Kim CG, Ryu KW, Kim YW, Sim JA, Yun YH, Choi IJ. Serial intermediate-term quality of life comparison after endoscopic submucosal dissection versus surgery in early gastric cancer patients. Surg Endosc 2018; 32: 2114–2122. https://doi.org/10.1007/s00464-017-5909-y CrossRefPubMed

30.

Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakaya N, Nakamura T, Shimosegawa T. A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early Gastric Cancer: "eCura system". Am J Gastroenterol 2017; 112: 874–881. https://doi.org/10.1038/ajg.2017.95 CrossRefPubMed

31.

Abdelfatah MM, Barakat M, Lee H, Kim JJ, Uedo N, Grimm I, Othman MO. The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis. Gastrointest Endosc 2018; 87: 338–347. https://doi.org/10.1016/j.gie.2017.09.025 CrossRefPubMed

32.

Suzuki S, Gotoda T, Hatta W, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Shimosegawa T. Survival Benefit of Additional Surgery After Non-curative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score Matching Analysis. Ann Surg Oncol 2017; 24: 3353–3360. https://doi.org/10.1245/s10434-017-6039-4 CrossRefPubMed

33.

Huang JY, Xu YY, Li M, Sun Z, Zhu Z, Song YX, Miao ZF, Wu JH, Xu HM. The prognostic impact of occult lymph node metastasis in node-negative gastric cancer: a systematic review and meta-analysis. Ann Surg Oncol 2013; 20: 3927–3934. https://doi.org/10.1245/s10434-013-3021-7 CrossRefPubMed

34.

Choi IJ, Kook MC, Kim YI, Cho SJ, Lee JY, Kim CG, Park B, Nam BH. Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer. N Engl J Med 2018; 378: 1085–1095. https://doi.org/10.1056/NEJMoa1708423 CrossRefPubMed

Title: Comparison of Long-Term Outcomes of Endoscopic Submucosal Dissection and Surgery for Early Gastric Cancer: a Systematic Review and Meta-analysis
Authors: Lihu Gu
Parikshit A. Khadaroo
Liangliang Chen
Xinlong Li
Hepan Zhu
Xin Zhong
Junhai Pan
Manman Chen
Publication date: 01-07-2019
Publisher: Springer US
Keywords: Gastrectomy
Gastric Cancer
Gastric Cancer
Gastrectomy
Published in: Journal of Gastrointestinal Surgery / Issue 7/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04227-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of Long-Term Outcomes of Endoscopic Submucosal Dissection and Surgery for Early Gastric Cancer: a Systematic Review and Meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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