P-0049 - Immediate and long-term outcome of ESD for differentiated intramucosal gastric cancer compared to surgical resection

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Gastric Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Min Park Sung
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors M. Park Sung1, B. Kim1, S. Kim Joon2, W. Lim Jung1
  • 1The Catholic University of Korea, Incheon/KR
  • 2Div. of Gastroenterology, Dept. of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon/KR

Abstract

Introduction

Endoscopic submucosal dissection (ESD) is now accepted as an alternative to surgery for the treatment of early gastric cancer (EGC). However, long-term clinical outcome of ESD for EGC compared to surgical resection has not been reported. The aim of this study is to evaluate the immediate and long-term clinical outcome of ESD for differentiated intramucosal gastric adenocarcinoma compared to surgical resection.

Methods

A retrospective analysis was performed in 103 consecutive patients who underwent ESD or surgical resection for differentiated intramucosal gastric adenocarcinoma from 2006 to 2008 in Incheon St. Mary's Hospital and Seoul St. Mary's Hospital, The Catholic University of Korea. Surveillance endoscopy and stomach computed tomography (CT) was performed regularly over 5 years in all patients. Immediate complications, overall survival and recurrence rates were compared between the two groups.

Results

Fifty eight patients received surgical resection and 45 patients received ESD. Patients treated by surgical resection sustained longer operative time compared to ESD (4.2 vs 1.3 hr, P = 0.026), had longer mean hospital stay (14.6 vs 7.2 days, P = 0.033), and had more blood loss (drop of hemoglobin level 1.54 vs 0.62 g/dl, P = 0.001). Metachronous lesion was detected in 6 patients (4 adenocarcinoma, 2 adenoma) among ESD group and none in surgical resection group during the follow up period (P = 0.001). Local recurrence was detected in 1 patient among surgical resection group. Distant metastasis was not detected in both groups. The 5-year overall and disease-specific survival rates were 100% in both groups.

Conclusion

ESD has post-operative benefits compared to surgical resection. ESD for differentiated intramucosal gastric adenocarcinoma might be acceptable considering the overall survival. However, meticulous surveillance program should be established because metachronous recurrence is more common after ESD.