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24.10.2017 | Ausgabe 4/2018

Surgical Endoscopy 4/2018

Serial intermediate-term quality of life comparison after endoscopic submucosal dissection versus surgery in early gastric cancer patients

Surgical Endoscopy > Ausgabe 4/2018
Young-Il Kim, Young Ae Kim, Chan Gyoo Kim, Keun Won Ryu, Young-Woo Kim, Jin Ah Sim, Young Ho Yun, Il Ju Choi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-017-5909-y) contains supplementary material, which is available to authorized users.
Young-Il Kim and Young Ae Kim contributed equally to this work.



Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is expected to provide better long-term health-related quality of life (HRQOL) by preserving the entire stomach. We aimed to compare serial changes in HRQOL characteristics between patients who underwent ESD versus surgery for EGC.


A gastric cancer patient cohort was prospectively enrolled from 2004 to 2007. HRQOL of 161 EGC patients was prospectively assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) and the stomach cancer-specific module EORTC-QLQ-STO22 at baseline (i.e., diagnosis) and at 1, 6, 12, 18, and 24 months of post-treatment.


Of 161 patients, 48 (29.8%) underwent ESD and 113 (70.2%) underwent surgery. HRQOL parameters of ESD patients were similar to or better than baseline values. At 1-month post-treatment, the surgery group had significantly poorer scores than the ESD group (P < 0.05) for factors except emotional and cognitive functioning, financial problems, anxiety, and hair loss. However, most of the HRQOL parameters in the surgery group improved during the first post-treatment year, with between-group differences becoming insignificant. Only five parameters (physical functioning, eating restriction, dysphagia, diarrhea, and body image) remained significantly better in the ESD group than the surgery group for > 1-year post-treatment (P < 0.05). The surgery group had significantly higher treatment-associated complications than the ESD group (15.0 vs. 2.1%; P = 0.017). The overall survival was not different between the both groups (5-year overall survival rates, 97.7% in the ESD group vs. 99.1% in the surgery group; P = 0.106 by the log-rank test).


Compared with surgery, ESD can provide better HRQOL benefits for EGC patients, especially during the early post-treatment period. However, surgical treatment should not be rejected only due to the concern about HRQOL impairments because most of them improved during follow-up periods.

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Supplementary material 1 (DOCX 21 KB)
Supplementary material 2 (DOCX 37 KB)
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