Early and long‑term outcomes of endoscopic submucosal dissection for early gastric cancer in a large patient series
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- Published online on: January 17, 2014 https://doi.org/10.3892/etm.2014.1488
- Pages: 594-598
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Abstract
Endoscopic submucosal dissection (ESD) enables the curative resection of early gastric cancer (EGC); however, little information is available on the long‑term outcomes of ESD. This study was conducted to clarify the clinical outcomes of a large number of patients with EGC who underwent ESD. The early outcomes were assessed in 1,209 patients and the long‑term outcomes were assessed in 300 patients at a follow‑up >5 years after the ESD procedure. The overall survival rates were compared between indication and expanded‑indication groups, and between the patients who did or did not undergo additional surgery in an out‑of‑indication group. Overall survival rates were also compared among different age groups. In total, 617 lesions were classed as the indication group, 507 as the expanded‑indication group and 208 as the out‑of‑indication group. Curative resection rates were 96.6% and 91.5% in the indication and expanded‑indication groups, respectively. In terms of the long‑term outcomes, 20 of the 146 patients in the indication group, 15 of the 105 patients in the expanded‑indication group and one of the 23 patients who underwent additional surgery in the out‑of‑indication group succumbed due to causes other than gastric cancer. Among the 26 patients who did not undergo additional surgery in the out‑of‑indication group, 10 mortalities occurred, including one due to gastric cancer. The five‑year survival rates were not significantly different between the indication and expanded‑indication groups. In the out‑of‑indication group, the five‑year survival rate for the patients who did not undergo additional surgery (65.0%) was significantly lower than that for those who did undergo additional surgery (100%) (P<0.01). The five‑year survival rate of patients aged >80 years (67.1%) was significantly lower than that of the younger patients (<60 years, 91.6%; sixties, 93.0%; seventies, 84.5%) (P<0.0001). In conclusion, although expanded‑indication of ESD for EGC is appropriate, comorbidities require consideration in elderly patients.
