Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a comparison study to surgery using propensity score-matched analysis.

BACKGROUND: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment in early gastric cancer (EGC) patients with negligible risk of lymph node metastasis. However, there are limited data regarding the long-term outcomes of ESD in comparison with surgery. This study aimed to compare the overall, recurrence-free, and metachronous cancer-free survival rates after ESD and surgery. METHODS: From May 2003 to December 2007, 391 patients with 413 EGCs and 258 patients with 276 EGCs were treated by ESD and surgery, respectively. According to inclusion criteria, 288 patients in the ESD group and 173 patients in the surgery group were eligible for this study. Using propensity score matching, 88 patients were analyzed per group. RESULTS: The overall survival rates were 92.0 % in the ESD group and 90.2 % in the surgery group. Local recurrence was observed in five patients (1.7 %) in the ESD group and distant recurrence in one patient (0.6 %) in the surgery group. Metachronous gastric cancers were detected in 14 patients (4.9 %) in the ESD group, whereas no patient in the surgery group. Kaplan-Meier curves exhibited no significant differences in overall or recurrence-free survival between the two groups. However, metachronous cancer-free survival of the ESD group was significantly lower than that of the surgery group (p = 0.002). In the ESD group, the late complication rate was significantly lower (0 vs. 6.8 %, p = 0.029), and the duration of hospital stay was shorter (7.3 vs. 14.2 days, p < 0.001), compared with the surgery group. CONCLUSIONS: The overall survival was similar between the ESD and surgery groups. Compared with surgery, the benefits of ESD included fewer late complications and shorter hospital stay duration.