title: Early and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in a large patient series.
abstract: Endoscopic submucosal dissection (ESD) enables the curative resection of early gastric cancer (EGC); however, little information is available on the long-term outcomes of ESD. This study was conducted to clarify the clinical outcomes of a large number of patients with EGC who underwent ESD. The early outcomes were assessed in 1,209 patients and the long-term outcomes were assessed in 300 patients at a follow-up >5 years after the ESD procedure. The overall survival rates were compared between indication and expanded-indication groups, and between the patients who did or did not undergo additional surgery in an out-of-indication group. Overall survival rates were also compared among different age groups. In total, 617 lesions were classed as the indication group, 507 as the expanded-indication group and 208 as the out-of-indication group. Curative resection rates were 96.6% and 91.5% in the indication and expanded-indication groups, respectively. In terms of the long-term outcomes, 20 of the 146 patients in the indication group, 15 of the 105 patients in the expanded-indication group and one of the 23 patients who underwent additional surgery in the out-of-indication group succumbed due to causes other than gastric cancer. Among the 26 patients who did not undergo additional surgery in the out-of-indication group, 10 mortalities occurred, including one due to gastric cancer. The five-year survival rates were not significantly different between the indication and expanded-indication groups. In the out-of-indication group, the five-year survival rate for the patients who did not undergo additional surgery (65.0%) was significantly lower than that for those who did undergo additional surgery (100%) (P<0.01). The five-year survival rate of patients aged >80 years (67.1%) was significantly lower than that of the younger patients (<60 years, 91.6%; sixties, 93.0%; seventies, 84.5%) (P<0.0001). In conclusion, although expanded-indication of ESD for EGC is appropriate, comorbidities require consideration in elderly patients.
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Ken
authors: K
authors: Ohnita
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Hajime
authors: H
authors: Isomoto
authors: Sankokai Miyazaki Hospital, Isahaya-shi, Nagasaki 854-0066, Japan.
authors: Saburo
authors: S
authors: Shikuwa
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Hiroyuki
authors: H
authors: Yajima
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Hitomi
authors: H
authors: Minami
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Kayoko
authors: K
authors: Matsushima
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Yuko
authors: Y
authors: Akazawa
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Naoyuki
authors: N
authors: Yamaguchi
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Eiichiro
authors: E
authors: Fukuda
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Hitoshi
authors: H
authors: Nishiyama
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Fuminao
authors: F
authors: Takeshima
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki-shi, Nagasaki 852-8501, Japan.
authors: Kazuhiko
authors: K
authors: Nakao
keywords: early gastric cancer; early outcomes; endoscopic submucosal dissection; long-term outcomes