Survival similar after submucosal dissection, surgery in early gastric cancer

Last Updated: 2017-05-12

By Reuters Staff

NEW YORK (Reuters Health) - Endoscopic submucosal dissection (ESD) may have advantages over surgery in patients with early gastric cancer (EGC) but overall survival rates are similar, according to South Korean researchers.

In a paper online April 10 in Gastric Cancer, Dr. Gwang Ha Kim and colleagues at Pusan National University Hospital, in Busan, note that the condition is one of the leading causes of cancer-related deaths worldwide, and the second most common cancer in Korea.

Rather than the traditional surgical approach, they add, endoscopic resection is commonly performed for EGC without lymph node metastasis (LNM). The survival rate is comparable to that of patients treated by surgical gastrectomy, but concerns have been expressed about the possible risk of subsequent LNM.

To investigate further, the researchers examined data on 617 patients with EGC who had been treated between 2005 and 2010. Of these, 342 had ESD and the remaining 275 underwent surgery.

The five-year overall survival rate in the ESD group (96.9%) were similar to that in surgery patients (98.1%). When propensity-score matching was used to compare 117 pairs of patients, there was also no significant difference in overall survival rates (96.5% vs. 99.1%) and disease-specific survival rates (100% vs. 99.1%).

However, the ESD group had a significantly lower disease-free survival rate (90.3% vs. 98.0%, p=0.002) and a significantly lower recurrence-free survival rate (95.1% vs. 98.0%, p=0.033).

The early complication rate was also significantly higher with ESD (6.7% vs. 1.5%, p<0.001). However, there were no late complications in ESD patients, while 9.1% had such complications in the surgery group (p<0.001). The ESD group also had a significantly shorter hospital stay (3 days vs. 10 days, p<0.001).

“In accordance with previous studies, our analysis showed that only patients in the ESD group developed metachronous gastric cancers," the researchers note. The rate was 9.1% and 29 of 31 such patients were successfully treated with repeated ESD. One refused additional treatment and the other received surgery.

No recurrences at regional lymph nodes or distant recurrence were seen in the ESD group. But, given the retrospective observational nature of the study and other limitations, the researchers stress, "Further prospective multicenter studies are needed to confirm our results."

Nevertheless, they conclude, "ESD might be a good treatment choice for EGC" in appropriately selected patients. But "careful regular surveillance endoscopy is essential to detect metachronous cancer at an early stage."

Dr. Kim did not respond to requests for comments.

SOURCE: http://bit.ly/2qcM0FN

Gastric Cancer 2017.