Clinical Outcomes Of Endoscopic Submucosal Dissection For Early Gastric Cancer With Three Different Indications

Objective: At present,Endoscopic Submucosal Dissection(ESD)has become an effective method in the treatment for Early Gastric Cancer(EGC),and its long-term efficacy and complication are still under ongoing follow-up studies.In particular,it is necessary to further clarify the postoperative efficacy of expanded and relative indications.The goal of this study is to evaluate the efficacy and complication of ESD treatment for EGC,and to study the efficacy difference of ESD treatment for EGC with different indications and the effectiveness of additional treatment under different indications after ESD treatment,so as to provide a useful reference for clinical practice.Methods: This study was a single-center retrospective study.A total of414 patients with 435 lesions who received ESD in Zhongda Hospital affiliated to Southeast University due to EGC from January 2015 to July 2021 were included in this retrospective study.The general data,preoperative endoscopic and histopathological reports,postoperative histopathological reports,operative data,and endoscopic follow-up data of the patients were collected.Statistical analysis was performed using SPSS 25.0(IBM,Armonk,NY,USA).T test or Kruskar-Wallis test is used for continuous variable.Chisquare test or Fisher’s exact test was used to compare the measured data of different groups.K-M survival analysis and log-rank test were used to compare the long-term efficacy of different group.P<0.005 was statistically significant.Results: The number of the patients in the absolute indication(AI),expanded indication(EI)and relative indication(RI)groups was 184,148 and82,respectively.The en bloc resection rate was 100%,100% and 98.8%(P =0.193).The complete resection rate was 98.5%,91.0% and 71.4%,respectively(P < 0.001).During a median follow-up of 41 months,the lymph node metastasis rate was 0.6%,0.7% and 0%(P =1.000).The distant metastasis rate was 0.0%,0.7% and 3.6%(P = 0.013).The five-year disease-specific survival rate in the RI group was 96.3%(P = 0.019),compared to 100.0% in the AI group and99.6% in the EI group.Conclusion: After ESD,the postoperative efficacy of EI group was the almost the same as the AI group.Patients in RI group also had favorable clinical efficacy after ESD,but regular follow-up examinations were still needed.ESD can also be used as a treatment for patients who are not suitable for surgical treatment.