Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications.

BACKGROUND

Current guidelines for endoscopic management such as EMR and endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) are in evolution, with broader indication criteria.

OBJECTIVE

To determine the clinical outcomes of endoscopic treatment, based on absolute indication and extended indication criteria and endoscopic methods.

DESIGN

Retrospective study.

SETTING

Tertiary-care, academic medical center.

PATIENTS

EMR or ESD was performed on 1627 cases of EGC in 1447 patients from July 1994 to January 2009.

INTERVENTION

EMR and ESD.

MAIN OUTCOME MEASUREMENTS

Clinical outcomes of EGC after EMR or ESD, based on the indication criteria.

RESULTS

Although the complete resection rate was higher (95.9% vs 88.4%; P < .001), and the complication rate was lower (6.8% vs 9.8%; P = .054) in the absolute than in the extended indication group, there was no between-group difference in the local recurrence rate (0.9% vs 1.1%; P = .783) at a median follow-up period of 32 months (interquartile range 22-48 months). In the extended indication group, ESD resulted in a significantly higher complete resection rate than EMR (83.0% vs 91.1%; P = .006).

LIMITATIONS

Retrospective study.

CONCLUSION

ESD in the extended indication group showed acceptable clinical outcomes with a relatively high complete resection rate and a low local recurrence rate.