Overall survival similar with surgery, endoscopic resection for early gastric cancer

Last Updated: 2016-02-03

By Will Boggs MD

NEW YORK (Reuters Health) - Endoscopic resection and surgery appear to offer similar overall survival rates for patients with early gastric cancer, though other cancer outcomes may be worse with the endoscopic method, according to a new observational study.

"When taking into account that endoscopic treatment ensures better quality of life, our study about oncologic outcome has clinical significance to provide evidence in choosing the treatment option for early gastric cancer," Dr. Hyuk Lee from Samsung Medical Center in Seoul, Korea, told Reuters Health by email.

"Endoscopic resection is a popular minimal invasive modality for stomach-preserving, but evidence on long-term outcome is scanty at this time," he said.

Using prospectively collected data, Dr. Lee and colleagues compared long-term outcomes and perioperative morbidity and mortality of endoscopic resection with those of surgery in patients with early gastric cancer who satisfied criteria for endoscopic resection.

A similar number of patients underwent endoscopic resection (n=1,290) and surgery (n=1,273), and median follow-up was 50 months (range, 24-144 months), the team reports in The American Journal of Gastroenterology, online January 19.

Ten-year overall survival, disease-specific survival (DSS), and recurrence-free survival (RFS) rates did not differ significantly between the endoscopic resection and surgery groups. But the 10-year disease-free survival (DFS) rate was significantly worse after endoscopic resection, mainly because of metachronous recurrence.

After propensity-score matching, the 10-year DFS, RFS, and metachronous RFS rates were significantly worse in the endoscopic resection group than in the surgery group. There was no significant difference in overall survival (80.1% and 80.8%, respectively) or DSS (98.0% and 96.9%), however.

Hospital length of stay was shorter after endoscopic resection than after surgery (median, 5 days vs. 11 days, p<0.001), but 30-day readmission rates and overall complication rates did not differ between the groups. The endoscopic resection group had more early complications, and the surgery group had more late complications.

Significant predictors of overall survival included old age, a Charlson Comorbidity Index >=2, an ECOG score >=2, male sex, an elevated tumor, and submucosal invasion.

"Endoscopic resection is not inferior to surgery with regard to overall survival in patients with early gastric cancer as long as this treatment is performed according to the appropriate criteria," Dr. Lee concluded. "As the disease-free survival, recurrence-free survival, and metachronous recurrence-free survival rates were lower in the endoscopic group, clinicians should emphasize the importance of endoscopic surveillance after endoscopic resection to patients."

SOURCE: bit.ly/1R1hAiP

Am J Gastroenterol 2016.