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01-06-2022 | Gastric Cancer | Review Article

Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated-type early gastric cancer meeting the expanded criteria: a systematic review and meta-analysis

Authors: Hyo-Joon Yang, Jie-Hyun Kim, Na Won Kim, Il Ju Choi

Published in: Surgical Endoscopy | Issue 6/2022

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).

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Title: Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated-type early gastric cancer meeting the expanded criteria: a systematic review and meta-analysis
Authors: Hyo-Joon Yang
Jie-Hyun Kim
Na Won Kim
Il Ju Choi
Publication date: 01-06-2022
Publisher: Springer US
Keywords: Gastric Cancer
Gastric Cancer
Published in: Surgical Endoscopy / Issue 6/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-022-09126-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated-type early gastric cancer meeting the expanded criteria: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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