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      A comparison of endoscopic submucosal dissection (ESD) and radical surgery for early gastric cancer: a retrospective study

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          Abstract

          Background

          Endoscopic submucosal dissection (ESD) has become one of the mainstays of treatment for early gastric cancer (EGC). Radical surgery is also a classical treatment method for EGC. There have been no systematic clinical studies of the curative effects and adverse events associated with ESD vs. radical surgery for EGC. This study investigated the therapeutic efficacy and safety of ESD and radical surgery for EGC.

          Methods

          Twenty-nine patients with EGC underwent ESD, and 59 underwent radical surgery at Weihai Municipal Hospital. The pathological characteristics, postoperative outcomes, hospital course, morbidity and mortality were retrospectively compared between the two groups.

          Results

          The oncological clearance was 93.1 % (27/29) in the ESD group. Postoperative delayed haemorrhage occurred in two patients. The hospital stay ranged from 10 to 23 days, and the average stay was 14.3 ± 3.7 days. The patients were followed-up for 1 to 5 years, with a mean follow-up of 26.9 ± 8.5 months. Regular endoscopic examinations showed that the wound had healed with no cancer recurrence in all of the patients. In the radical surgery group, the oncological clearance was 100 % (59/59). The hospital stay ranged from 11 to 55 days, and the average stay was 21.7 ± 9.3 days. The patients were followed-up for 1 to 3.7 years, with a mean follow-up of 22.3 ± 9.4 months. Nine patients developed complications, including acute postoperative adhesive ileus (1/59) and symptomatic residual gastritis (3/59). These complications were improved by an additional operation, drainage, gastrointestinal decompression and comprehensive therapy.

          Conclusions

          ESD achieved similar efficacy and had many advantages compared with radical surgery for the treatment of EGC.

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          Most cited references 37

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          Recent patterns in gastric cancer: a global overview.

          Until the mid-1990s, gastric cancer has been the first cause of cancer death worldwide, although rates had been declining for several decades and gastric cancer has become a relatively rare cancer in North America and in most Northern and Western Europe, but not in Eastern Europe, Russia and selected areas of Central and South America or East Asia. We analyzed gastric cancer mortality in Europe and other areas of the world from 1980 to 2005 using joinpoint regression analysis, and provided updated site-specific incidence rates from 51 selected registries. Over the last decade, the annual percent change (APC) in mortality rate was around -3, -4% for the major European countries. The APC were similar for the Republic of Korea (APC = -4.3%), Australia (-3.7%), the USA (-3.6%), Japan (-3.5%), Ukraine (-3%) and the Russian Federation (-2.8%). In Latin America, the decline was less marked, but constant with APC around -1.6% in Chile and Brazil, -2.3% in Argentina and Mexico and -2.6% in Colombia. Cancers in the fundus and pylorus are more common in high incidence and mortality areas and have been declining more than cardia gastric cancer. Steady downward trends persist in gastric cancer mortality worldwide even in middle aged population, and hence further appreciable declines are likely in the near future.
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            Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms.

            The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Retrospective study from a single institution. From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa. Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes. The rates of en bloc resection and complete resection were 100% and 88%, respectively. Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectively. This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution. This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically.
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              Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer.

              The purpose of this study was to define the measurement properties and clinical validity of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to assess health-related quality of life (HRQL) in gastric cancer. The EORTC gastric cancer module, QLQ-STO 22, was administered with the QLQ-C30, core questionnaire, to 219 patients undergoing treatment with curative or palliative intent before and after treatment. Reliability and validity of the module was tested and patients' debriefing comments analysed. Compliance rates were high, questionnaires well accepted and less than 4% of items had missing data. Multi-trait scaling analyses and face validity refined the module to five scales and four single items. Scales distinguished between clinically distinct groups of patients and demonstrated treatment-induced changes over time. Test-retest scores demonstrated good reliability. The EORTC QLQ-STO 22 demonstrates psychometric and clinical validity that supports its use to supplement the EORTC QLQ-C30 to assess quality of life in patients with gastric cancer undergoing surgery, surgery and chemoradiotherapy, palliative chemotherapy, palliative surgery and best supportive care.
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                Author and article information

                Contributors
                0086-631-5287097 , fqy51886@163.com
                swc1975@hotmail.com
                95357033@qq.com
                Journal
                World J Surg Oncol
                World J Surg Oncol
                World Journal of Surgical Oncology
                BioMed Central (London )
                1477-7819
                4 November 2015
                4 November 2015
                2015
                : 13
                Affiliations
                Gastroenterology Division, Weihai Municipal Hospital, Weihai, 264200 People’s Republic of China
                Article
                724
                10.1186/s12957-015-0724-1
                4634741
                26537433
                © Song et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Surgery

                early gastric cancer, endoscopic submucosal dissection, radical operation

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