Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Endoscopic submucosal dissection (ESD) allows en bloc resection of early gastric cancer (EGC), but long-term outcomes are not well-established.
• Conventional endoscopic mucosa resection has limitations compared to ESD for EGC.
• Assessing the long-term clinical outcomes of ESD for EGC is crucial.

Purpose of the Study:

• To evaluate tumour recurrence and survival rates in patients with EGC treated with ESD.
• To determine the factors influencing curative resection and complications after ESD.
• To assess the long-term prognosis of EGC following ESD treatment.

Main Methods:

• ESD was performed on 551 patients with 589 EGC lesions meeting expanded criteria.
• Follow-up included endoscopic surveillance and metastatic surveys for a median of 30 months (range 6-89 months).
• Outcomes assessed included en bloc resection rate, curative resection rate, complications, and survival rates.

Main Results:

• En bloc resection was achieved in 94.9% of lesions; larger lesions had a higher risk of piecemeal resection.
• A curative resection rate of 94.7% was achieved, with en bloc resection being the sole significant predictor of curability.
• Patients with non-curative resections experienced more local recurrence. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively.

Conclusions:

• Precise curability assessment and successful en bloc resection are key to reducing tumour recurrence after ESD.
• The prognosis for EGC patients treated with ESD appears excellent.
• Further extended follow-up studies are recommended to confirm these long-term outcomes.