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Meng ZW, Bishay K, Vaska M, Ruan Y, Al-Haddad MA, Elhanafi SE, Qumseya BJ, Belletrutti PJ, Gill R, Debru E, Heitman SJ, Brenner DR, Forbes N. Endoscopic Submucosal Dissection Versus Surgery or Endoscopic Mucosal Resection for Metachronous Early Gastric Cancer: a Meta-analysis. J Gastrointest Surg 2023; 27:2628-2639. [PMID: 37752384 DOI: 10.1007/s11605-023-05840-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Resection options for early gastric cancer (EGC) include endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and surgery. In patients with metachronous EGC following previous resection, the optimal resection technique is not well elucidated. We conducted a systematic review and meta-analysis of studies comparing ESD to EMR, or ESD to surgery, in patients with metachronous EGC. METHODS We conducted an electronic search of studies reporting on outcomes and AEs following ESD versus either EMR or surgery for patients with metachronous EGC. Pooled odds ratios (OR) of included studies were obtained using DerSimonian and Laird random effects models. Funnel plots were produced and visually inspected for evidence of publication bias. The quality of the evidence was assessed using GRADE. RESULTS A total of 9367 abstracts were screened and 10 observational studies were included. The odds of complete resection were higher amongst patients undergoing ESD compared to EMR (OR 5.88, 95% confidence intervals, CI, 1.79-19.35), whereas the odds of complete resection were no different between ESD and surgery (OR 0.57, 95% CI 0.04-8.24). There were no differences in the odds of local recurrence with ESD versus surgery (OR 5.01, 95% CI 0.86-29.13). Post-procedural bleeding did not differ significantly between ESD and EMR (OR 0.70, 95% CI 0.16-3.00). There was no evidence of publication bias. DISCUSSION For metachronous EGC, ESD or surgery is preferred over EMR depending on local expertise and patient preferences, largely due to a higher risk of incomplete resection with EMR. REVIEW REGISTRATION PROSPERO CRD42021270445.
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Affiliation(s)
- Zhao Wu Meng
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, CWPH 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kirles Bishay
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, CWPH 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary, AB, Canada
| | - Yibing Ruan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | | | - Sherif E Elhanafi
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University, El Paso, TX, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, University of Florida, Gainesville, FL, USA
| | - Paul J Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, CWPH 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Richdeep Gill
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Estifanos Debru
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Steven J Heitman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, CWPH 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Nauzer Forbes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, CWPH 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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