Yamaguchi T, Kadoya S, Hayashi K, Gunjigake K, Sakimura Y, Ohbatake Y, Terai S, Kitamura H, Bando H, Inaki N. Non-inferiority of additional gastrectomy after endoscopic submucosal dissection compared with surgery alone on long-term prognosis: A propensity score-matching analysis.
J Gastrointest Surg 2024:S1091-255X(24)00529-8. [PMID:
38964536 DOI:
10.1016/j.gassur.2024.06.027]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND
Patients in whom endoscopic submucosal dissection (ESD) has resulted in non-curative resection need further surgical treatment. However, the oncological outcome of additional gastrectomy after ESD compared with surgery alone remains unclear.
METHODS
The clinical data of 778 patients who underwent gastrectomy for early gastric cancer from January 2008 to December 2019 in Ishikawa Prefectural Central Hospital were retrospectively analyzed. Of these 778 patients, 187 underwent additional gastrectomy after ESD (ESD (+) group) and 591 underwent surgery alone (ESD (-) group). We compared the overall survival and disease-free survival between the ESD (+) and ESD (-) groups, using propensity score matching to adjust for baseline characteristics. We also assessed early postoperative outcomes.
RESULTS
After propensity score matching based on sex, age, tumor diameter, tumor gross type, and operative procedure, each group comprised 144 patients with no significant differences in clinical background characteristics. After matching, the 5-year overall survival rate in the ESD (+) and ESD (-) group was 90.9% and 87.8%, respectively, with no significant difference (P = 0.470). In addition, there was no significant difference in the disease-free survival rate (97.6% vs. 95.8%, respectively; P = 0.504). The postoperative complication rate was similar in both groups.
CONCLUSION
Additional gastrectomy for patients in whom ESD resulted in non-curative resection did not adversely affect the long-term prognosis. Additional gastrectomy after ESD is oncologically acceptable for early gastric cancer.
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