Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study

Dig Endosc. 2014 Mar;26(2):183-91. doi: 10.1111/den.12099. Epub 2013 Apr 7.

Abstract

Background: The aim of the present study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) based on the long-term outcomes.

Patients and methods: From June 2002 to March 2007, ESD was carried out in 472 cases and 570 lesions of EGC. Post-surgical cases and status-unknown cases were excluded. The following long-term outcomes were examined in 438 patients who were reliably followed up for at least 5 years after treatment (range: 5 years [60 months] to 9 years, 9 months [117 months]): local recurrence, metachronous recurrences, and the survival rate.

Results: The overall en bloc resection rate was 97.7% for all lesions treated by ESD. The median procedure time was 47.0 min (range 8-345 min). The incidence of positive horizontal andvertical margins was 3.7% and 3.4%, respectively. The incidence of perforation and postoperative bleeding was 5.3% and 4.3%, respectively. There were no deaths related to ESD. Local recurrence was observed in five patients (1.1%), and metachronous recurrences in 7.8% of the patients. The post-treatment 5-year survival was 83.1%. There were no deaths as a result of gastric cancer associated with sites treated by ESD.

Conclusion: ESD can be considered a standard treatment for EGC based on its expanded indications and low incidences of local recurrence and lymph node metastasis.

Keywords: endoscopic submucosal dissection (ESD); gastric cancer; long-term outcome.

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / surgery*
  • Adenocarcinoma, Papillary / diagnosis
  • Adenocarcinoma, Papillary / surgery
  • Aged
  • Dissection / methods*
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Follow-Up Studies
  • Gastric Mucosa / pathology
  • Gastric Mucosa / surgery*
  • Humans
  • Incidence
  • Japan / epidemiology
  • Male
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging*
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Stomach Neoplasms / diagnosis
  • Stomach Neoplasms / surgery*
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome