title: Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience.
abstract: BACKGROUND
  In Korea, endoscopic submucosal dissection (ESD) has been widely accepted for the treatment of early gastric cancers (EGCs). However, the understanding of the long-term clinical outcome of ESD for EGC remains insufficient. Therefore, the aim of the present study was to assess the long-term clinical outcome and efficacy of ESD for the treatment of EGCs, including the clinical application of the expanded criteria for ESD.
  
  
  METHODS
  From January 2006 to December 2010, a total of 515 patients with 522 EGCs were treated by ESD in our hospital; study enrollment was based on the expanded criteria. Comparisons of resectability (en bloc or piecemeal resection), curability (curative or non-curative), and complications (bleeding and perforation) between the standard and expanded groups were assessed. Thereafter, 336 patients with 342 EGCs were finally included in a long-term analysis of local tumor recurrence, development of synchronous and metachronous cancers, and overall and disease-specific survival rates.
  
  
  RESULTS
  En bloc and curative resection rates of 96.7 % and 88.3 %, respectively, were achieved. The curative resection rate was significantly lower in the expanded group than in the standard group (82.1 % vs. 91.5 %, p = 0.001). During a median follow-up of 24 months, the local tumor recurrence rate was also higher in the expanded group than in the standard group (7.0 % vs. 1.8 %, p = 0.025). Local recurrence was more frequent in lesions with non-curative resection than in those with curative resection (20.0 % vs. 1.3 %, p < 0.001). The 5-year overall and disease-specific survival rates were 88 % and 100 %, respectively; the difference between the standard and expanded groups was not significant (p = 0.834).
  
  
  CONCLUSIONS
  ESD appears to be a feasible and effective method for treating EGCs, based on the standard and expanded criteria. Close follow-up surveillance, after ESD, should be standard for all patients.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea, cutegor@naver.com.
authors.forename: Mun Ki
authors.initials: MK
authors.lastname: Choi
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
authors.forename: Dong Uk
authors.initials: DU
authors.lastname: Kim
authors.forename: Dong Yup
authors.initials: DY
authors.lastname: Ryu
authors.forename: Bong Eun
authors.initials: BE
authors.lastname: Lee
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Cheong
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome