Original articleClinical endoscopyLong-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection
Section snippets
Study population
This study was a retrospective cohort study of 665 patients who underwent gastrectomy or ER for EGC at the Center for Gastric Cancer in the National Cancer Center between January 2002 and December 2007. We included patients who met the following inclusion criteria: (1) 20 years of age and older, (2) newly diagnosed EGC without previous treatment, (3) histologically confirmed well- or moderately differentiated adenocarcinoma, (4) intramucosal tumor without ulceration and 2 cm or less in
Baseline and clinicopathological characteristics
Baseline and clinicopathological characteristics are summarized in Table 1. Of all included patients, 261 patients underwent ER (ER group), and 114 underwent surgery (surgery group). The median age of the 375 patients was 62 years, and there were 283 (75.5%) men. Most tumors (94.4%, 354/375) were located in the middle third or lower third of the stomach. Patients in the ER group had significantly smaller tumors and fewer moderately differentiated adenocarcinomas than those in the surgery group.
Discussion
This study was conducted to compare the long-term outcomes of ER with those of surgery as curative treatments of EGC lesions that met the criteria for absolute indication. During the median follow-up period of 76.4 months, we found that the OS rate after ER was comparable to that achieved by surgery. Although metachronous gastric cancers after treatment occurred more commonly, adverse events were less frequent in the ER group than in the surgery group.
There are several reasons why long-term
References (33)
- et al.
Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications
Gastrointest Endosc
(2011) - et al.
EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes
Gastrointest Endosc
(2011) - et al.
The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm
Gastrointest Endosc
(2005) - et al.
A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer
Gastrointest Endosc
(2012) - et al.
Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication
Dig Liver Dis
(2013) Cancer control activities in the Republic of Korea
Jpn J Clin Oncol
(2008)- et al.
Trends in cancer screening rates among Korean men and women: results from the Korean national cancer screening survey (KNCSS), 2004-2011
Cancer Res Treat
(2012) Japanese gastric cancer treatment guidelines 2010 (ver. 3)
Gastric Cancer
(2011)- et al.
Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry
Gastric Cancer
(2013) - et al.
Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: a retrospective cohort analysis
J Surg Oncol
(2010)
Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study
Gut
Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract
J Clin Oncol
Endoscopic treatment for early gastric cancer
J Gastric Cancer
Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria
Br J Surg
Longterm outcomes after endoscopic mucosal resection for early gastric cancer
Gastric Cancer
Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study
Surg Endosc
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2022, Surgery (United States)Citation Excerpt :While the most recent rendition of the JGCA guidelines was disseminated in 2018, the core concepts of endoscopic eligibility have been present for over 10 years. By following these criteria rigorously, local excision can be applied with accurate staging and excellent oncologic outcomes.14,15 However, if eCura criteria are not appropriately followed, patients suffer a significant risk of under-staging and under-treatment.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This work was supported by grant 1310280 from the National Cancer Center, South Korea.
See CME section; p. 439.
Current affiliation of Dr Jun Ho Lee is the Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
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Drs Il Ju Choi and Jun Ho Lee contributed equally to this work.