For early gastric CA, endoscopic submucosal dissection may be better than surgery

Last Updated: 2016-07-25

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Some patients with expanded-indication lesions of differentiated-type early gastric cancer (EGC) may do better after endoscopic submucosal dissection (ESD) than after surgery, new research from Japan suggests.

"We demonstrated that, overall, the long-term survival of patients who underwent ESD for expanded-indication lesions of differentiated-type EGC was significantly longer than the long-term survival of patients who underwent surgery," said co-author Dr. Yasuaki Nagami of Osaka City University Graduate School of Medicine.

"Our results indicate that ESD may offer an alternative treatment for expanded-indication lesions of differentiated-type EGC due to its favorable long-term outcomes and its lack of severe adverse events compared with those of surgery," he told Reuters Health by email. "Patient care may be improved by the decreased need for care of adverse events, ability to eat normally after treatment, and better cost effectiveness."

"However, ESD for these EGC lesions remains an investigational treatment," he added.

Dr. Nagami and his colleagues used propensity-score matching and inverse-probability-of-treatment weighting (IPTW) to retrospectively investigate 1,500 consecutive patients with ECG who underwent ESD or surgery over roughly 16 years at one academic hospital in Japan.

Overall, 308 patients with expanded-indication lesions of differentiated-type EGC confirmed by pathological examination after ESD or surgery were eligible for study, the researchers report in Gastrointestinal Endoscopy, online June 27.

In patients having multiple treatments for different lesions, the first treated lesion was considered representative, and all lesions were evaluated pathologically according to the expanded histological criteria for endoscopic resection in the 2010 Japanese gastric cancer treatment guidelines.

The researchers performed annual endoscopy after each treatment and contrast-enhanced computed tomography once or twice a year to detect lymph-node and distant metastases. They collected long-term outcome data from medical records at follow-up visits, and incomplete or missing data were obtained by phone interview.

The five-year overall survival rate after propensity-score matching was higher in the ESD group than in the surgery group (97.1% vs. 85.8%, p=0.01).

Surgery was associated with higher mortality using IPTW (hazard ratio, 10.89; p<0.01) as well as Cox analysis (HR, 8.60; p=0.04) after propensity matching.

Significantly fewer adverse events occurred in the ESD group than in the surgery group (6.8% vs. 28.4%, p<0.01), and no cause-specific mortality was found in either group.

The authors say the study's strengths include its use of propensity-matched analysis to reduce the selection bias; its assessment of only patients who underwent ESD for a differentiated-type EGC that strictly met the curative histological expanded criteria; and its adjustment for American Society of Anesthesiologists Physical Status (ASA-PS) score, which was a predictive factor for post-op adverse events and mortality after major abdominal surgeries.

Its limitations include its retrospective design; small sample size; short observation period; and differences in treatment selected, which may have affected mortality rates.

The study did not receive any funding.

SOURCE: http://bit.ly/2a7SlZK

Gastrointest Endosc 2016.