Endoscopic resection versus radical gastrectomy for early gastric cancer in Asia: A meta-analysis

Fei-Long Ning; Chun-Dong Zhang; Peng Wang; Shuai Shao; Dong-Qiu Dai

doi:10.1016/j.ijsu.2017.09.068

Endoscopic resection versus radical gastrectomy for early gastric cancer in Asia: A meta-analysis

Int J Surg. 2017 Dec:48:45-52. doi: 10.1016/j.ijsu.2017.09.068. Epub 2017 Oct 5.

Authors

Fei-Long Ning¹, Chun-Dong Zhang², Peng Wang², Shuai Shao², Dong-Qiu Dai³

Affiliations

¹ Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, Jiangsu, China; Department of General Surgery, Affiliated Xuzhou Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China.
² Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
³ Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Cancer Research Institute, China Medical University, Shenyang, Liaoning, China; Cancer Center, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. Electronic address: daidq63@163.com.

PMID: 28987558
DOI: 10.1016/j.ijsu.2017.09.068

Abstract

Background: To compare the efficacy and safety of endoscopic resection (ER) and radical gastrectomy (RG) for early gastric cancer (EGC) in Asia.

Materials and methods: We systematically searched relevant articles published before September 1, 2017. We evaluated the quality of the included non-randomized studies using the Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using RevMan 5.3 software. The odds ratio (OR) with 95% confidence intervals (CI) were used for the dichotomous data.

Results: Fifteen retrospective studies were included in this analysis (3737 patients in the ER group and 4246 patients in RG group). No significant differences in the three-year survival rate (OR, 0.87; 95%CI, 0.50-1.53) and five-year survival rate (OR, 0.81; 95%CI, 0.58-1.13) between the ER and RG groups were observed. Although patients undergoing ER had a higher risk of recurrence (OR, 6.07; 95%CI 4.17-8.84) and the occurrence of metachronous cancer (OR, 8.35; 95%CI, 5.48-12.75), recurrent or metachronous gastric cancers following ER were successfully detected and removed using the endoscopic technique. Higher recurrence in the ER group may be associated with its lower en bloc resection rate (OR, 0.05; 95%CI, 0.02-0.14) and complete resection rate (OR, 0.03; 95%CI, 0.01-0.08). Importantly, although the three-year survival and five-year survival were similar in the two groups, the complication rate in the ER group was significantly lower than that in the RG group.

Conclusion: ER is a good choice for patients with small EGC lesions (≤2 cm) without lymph node metastasis, especially in elderly patients with various medical comorbidities and in patients who cannot tolerate abdominal surgery or who meet the criteria but decline surgery. In contrast, RG is recommended when the diameter of the tumor is large (>2 cm) and preoperative examination suggests the possible presence of lymph node metastasis.

Keywords: Asia; Early gastric cancer; Endoscopic resection; Meta-analysis; Radical gastrectomy.

Publication types

Meta-Analysis
Review

MeSH terms

Aged
Asia
Early Detection of Cancer
Female
Gastrectomy / methods*
Gastroscopy / methods*
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local / epidemiology
Odds Ratio
Retrospective Studies
Stomach Neoplasms / diagnosis
Stomach Neoplasms / pathology
Stomach Neoplasms / surgery*
Survival Rate
Treatment Outcome
Tumor Burden