Long-term outcome of endoscopic resection versus surgery in early gastric cancer meeting the expanded indication

Study aim: The aim of this study was to evaluate long-term outcomes of endoscopic resection (ER) compared to surgery for early gastric cancer (EGC) meeting the expanded indication. Methods: We retrospectively reviewed data from patients who underwent ER or surgery for EGC meeting the expanded indication between 2001 and 2009. Overall survival (OS) was the primary outcome; metachronous gastric cancer rates and complication rates were secondary outcomes. Results: Among 457 patients included, 165 underwent ER and 292 underwent surgery, and the median follow-up duration was 58.6 months. The 5-year OS rates were 97.5% and 97.0% for ER and surgery, respectively, and Kaplan-Meier analysis showed no significant difference (P=0.425). Multivariate analysis showed no significant difference in OS for ER (adjusted hazard ratio for overall mortality, 0.55; P=0.270) compared with that for surgery. However, metachronous gastric cancer developed only in the ER group (9/165, 5.5%). Despite the higher rate of metachronous cancers in the ER group, most of them (8/9, 88.9%) were curatively treated with repeated ER. Early complication rates were similar for ER and surgery (P=0.557), whereas late complications occurred only following surgery (P=0.004). Conclusion: long-term survival rates after ER for EGCs meeting the expanded indication were comparable to those of surgery.