Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection

Il Ju Choi, Jun Ho Lee, Young Il Kim, Chan Gyoo Kim, Soo Jeong Cho, Jong Yeul Lee, Keun Won Ryu, Byung Ho Nam, Myeong Cherl Kook, Young Woo Kim

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Abstract

Background Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes. Objective To compare long-term outcomes of ER with those of surgery in patients with EGC who met the absolute indication for ER. Design Retrospective cohort study. Setting A specialized center for the treatment of cancer. Patients and Interventions We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Main Outcome Measurements The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score. Results Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7% vs 93.6%, respectively; P =.725 by log-rank test). There were no gastric cancer-related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1%, 16/261) than in the surgery group (0.9%, 1/114) (P =.024). However, most patients (93.8%, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9% vs 2.7%, P =.028). Limitations Retrospective, single-center study. Conclusions The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.

Original languageEnglish
Pages (from-to)333-341.e1
JournalGastrointestinal Endoscopy
Volume81
Issue number2
DOIs
StatePublished - 1 Feb 2015

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Stomach Neoplasms
Survival Rate
Neoplasms
Propensity Score
Survival
Gastrectomy
Adenocarcinoma
Cohort Studies
Retrospective Studies
Regression Analysis

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Choi, Il Ju ; Lee, Jun Ho ; Kim, Young Il ; Kim, Chan Gyoo ; Cho, Soo Jeong ; Lee, Jong Yeul ; Ryu, Keun Won ; Nam, Byung Ho ; Kook, Myeong Cherl ; Kim, Young Woo. / Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. In: Gastrointestinal Endoscopy. 2015 ; Vol. 81, No. 2. pp. 333-341.e1.
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title = "Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection",
abstract = "Background Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes. Objective To compare long-term outcomes of ER with those of surgery in patients with EGC who met the absolute indication for ER. Design Retrospective cohort study. Setting A specialized center for the treatment of cancer. Patients and Interventions We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Main Outcome Measurements The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score. Results Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7{\%} vs 93.6{\%}, respectively; P =.725 by log-rank test). There were no gastric cancer-related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1{\%}, 16/261) than in the surgery group (0.9{\%}, 1/114) (P =.024). However, most patients (93.8{\%}, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9{\%} vs 2.7{\%}, P =.028). Limitations Retrospective, single-center study. Conclusions The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.",
author = "Choi, {Il Ju} and Lee, {Jun Ho} and Kim, {Young Il} and Kim, {Chan Gyoo} and Cho, {Soo Jeong} and Lee, {Jong Yeul} and Ryu, {Keun Won} and Nam, {Byung Ho} and Kook, {Myeong Cherl} and Kim, {Young Woo}",
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Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. / Choi, Il Ju; Lee, Jun Ho; Kim, Young Il; Kim, Chan Gyoo; Cho, Soo Jeong; Lee, Jong Yeul; Ryu, Keun Won; Nam, Byung Ho; Kook, Myeong Cherl; Kim, Young Woo.

In: Gastrointestinal Endoscopy, Vol. 81, No. 2, 01.02.2015, p. 333-341.e1.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection

AU - Choi, Il Ju

AU - Lee, Jun Ho

AU - Kim, Young Il

AU - Kim, Chan Gyoo

AU - Cho, Soo Jeong

AU - Lee, Jong Yeul

AU - Ryu, Keun Won

AU - Nam, Byung Ho

AU - Kook, Myeong Cherl

AU - Kim, Young Woo

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes. Objective To compare long-term outcomes of ER with those of surgery in patients with EGC who met the absolute indication for ER. Design Retrospective cohort study. Setting A specialized center for the treatment of cancer. Patients and Interventions We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Main Outcome Measurements The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score. Results Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7% vs 93.6%, respectively; P =.725 by log-rank test). There were no gastric cancer-related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1%, 16/261) than in the surgery group (0.9%, 1/114) (P =.024). However, most patients (93.8%, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9% vs 2.7%, P =.028). Limitations Retrospective, single-center study. Conclusions The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.

AB - Background Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes. Objective To compare long-term outcomes of ER with those of surgery in patients with EGC who met the absolute indication for ER. Design Retrospective cohort study. Setting A specialized center for the treatment of cancer. Patients and Interventions We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Main Outcome Measurements The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score. Results Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7% vs 93.6%, respectively; P =.725 by log-rank test). There were no gastric cancer-related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1%, 16/261) than in the surgery group (0.9%, 1/114) (P =.024). However, most patients (93.8%, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9% vs 2.7%, P =.028). Limitations Retrospective, single-center study. Conclusions The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.

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DO - 10.1016/j.gie.2014.07.047

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