Published online Feb 15, 2019. doi: 10.4251/wjgo.v11.i2.161
Peer-review started: October 16, 2018
First decision: December 7, 2018
Revised: December 17, 2018
Accepted: December 23, 2018
Article in press: December 23, 2018
Published online: February 15, 2019
Processing time: 123 Days and 5.2 Hours
There are several surgical options for treating early gastric cancers (EGCs), such as endoscopic resection, laparoscopic or open gastrectomy. The role of endoscopic submucosal dissection (ESD) in treating EGC is not well established, especially when compared with resection surgery.
In this study, the authors aim to compare the safety and efficacy of the short- and long-term outcomes between ESD and resection surgery.
The databases from January 1990 to June 2018 of PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. The enrolling studies reporting short- or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. By using either fixed- or random-effects models depending on heterogeneity across studies, the pooling analysis was conducted.
Fourteen studies comprising 5112 patients were eligible for analysis. This meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time, shorter hospital stay, and lower postoperative complication rate. And the EGC patients who underwent ESD had higher recurrence rate than resection surgery patients. However, the long-term survival including overall survival and event-free survival showed no significant differences between these two groups.
This meta-analysis suggested that ESD is safe and feasible in comparison with resection surgery in treating EGC, with clinical advantages in operation time, hospital stay, and postoperative complications. The long-term survival also supported the safety of ESD compared with resection surgery, although with some differences in tumor recurrence rate.
The further multi-center and prospective randomized controlled trials with longer and standard follow-up strategies are warranted to verify the findings of the study.