Endoscopic Submucosal Dissection Compared With Surgery For Treatment Of Early Gastric Cancer

Objective: This study aimed to compare the therapeutic outcomes and quality of life(QOL)after treatment between endoscopic submucosal dissection(ESD) and surgery for treatment of early gastric cancer(EGC).Methods: This is a retrospective study including cases of EGC or severe dysplasia treated at the second hospital of Lanzhou university from October 2007 to October 2015.these cases were divided into ESD group and surgery group according to the treatment method. The data including tumor characteristics,health economics, short-term outcomes and long-term outcomes were compared between two groups.Results: From October 2007 to October 2015, 234 EGC patients were enrolled in this study. Of these patients, 81 underwent ESD and 153 underwent surgery. There was no difference in age, gender, symptoms, comorbidity and tumor characteristics. More patients in the surgery group had short-term complications(19.0% vs. 8.6%; p =0.001). Patients treated by surgery sustained longer operative time(79.2±26.3 vs. 225.5±69.1mins; p<0.001), postoperative Fasting time(2.6±1.0 vs. 6.9±2.3 days; p<0.001), gastrointestinal decompression time(1.4±1.2 vs. 6.6±2.3 days; p<0.001),hospital stay time after operation(7.2±2.4 vs. 14.0±4.6 days; p<0.001) and hospital stay time(12.5±4.6 vs. 20.9±6.1 days; p<0.001).The operation cost, examinations cost and total cost were significantly less in the ESD group than the surgery group(p<0.001, respectively). We followed up 187 patients of 234 EGC patients, 70 patients in the ESD group and 117 patients in the surgery group in our study. Local recurrence was observed in 2 patients(2.86%) and metachronous gastric cancers were detected in 2 patients(2.86%) in the ESD group,whereas no patient in the surgery group. More patients in the surgery group had long-term complications(4.3% vs. 17.9 %; p =0.018).The five-year survival rate was 92.9% in the ESD group and 91.8% in the surgery group. Kaplan–Meier curves exhibited no significant differences in overall survival between the two groups. But the QOL was better in the ESD group than in the surgery group according to the quality of life questionnaire(QLQ)of 79 EGC patients after treatment.Conclusions: ESD is an effective treatment with preservation of the stomach in selected EGC Patients. The five-year survival rate is similar between the ESD and surgery groups.However, ESD should be the first choice because of its less invasive, faster recovery,fewer complications,shorter hospitalization time,lower costs and better QOL.