Comparison of the Clinical and Prognosis Risk Factors Between Endoscopic Mucosal Dissection/Endoscopic Mucosal Resection and Radical Gastrectomy for Early-Stage Gastric Cancer.

Abstract

Abstract Aim: This study aimed to explore the efficacy and safety of endoscopic mucosal dissection/endoscopic mucosal resection (ESD/EMR), laparoscopic-assisted radical gastrectomy (LARG), and open radical gastrectomy (ORG) in early-stage gastric cancer. Methods: A total of 417 patients with early-stage gastric cancer who were admitted in two hospitals from January 1, 2014 to July 31, 2017 were selected; the patients were divided into the ESD/EMR group (139 cases), LARG group (108 cases), and ORG group (170 cases) according to the operation methods used. The baseline data, economic cost of health, oncologic characteristics, postoperative complications, 5-year overall survival and disease-free survival, and risk factors of death were compared and analyzed. Results: No significant difference was observed in the baseline data among the three patient groups (P>0.05). The total hospitalization days, operation time, postoperative fluid intake time, hospitalization expenses, and proportion of antibiotic use rate in the ESD/EMR group were lesser than those in other groups (P<0.05). The LARG group has a longer operation time and higher hospitalization expenses compared with the ORG group (P<0.05), but the total hospitalization days, postoperative fluid intake time, proportion of antibiotic use, and lung infection status were consistent. The ESD/EMR group had a lower incidence of incisionsite infection and postoperative abdominal distension compared with that of the surgerygroups (P<0.05). Five patients required radical surgery after undergoing ESD/EMR (all 5 had residual tissue margin cancer), while none of the patients had switched to ORG during LARG. Surgery had advantages over ESD/EMR in terms of lymph node dissection (P<0.05). No significant differences were observed in the postoperative complications such as upper gastrointestinal bleeding, perforation, liver metastasis, pancreatic metastasis, recurrence,incision hernia, and reoperation (P>0.05). The 5-year postoperative survival rates of patients in the three groups were 94.2% (ESD/EMR), 93.5% (LARG), and 94.7% (ORG), respectively, with no significant differences (P>0.05). The binary logistics multivariate analysis showed that the tumor size, invasion depth, vascular invasion, and differentiated degree were risk factors for death in patients with gastric cancer. Conclusions: No significant difference was observed between ESD/EMR and radical surgery. However, standardized criteria for excluding metastatic lymph nodes should be established to promote ESD/EMR.