title: Long-term clinical outcomes of endoscopic resection for early gastric cancer.
abstract: BACKGROUND
  We aimed to evaluate long-term clinical outcomes of endoscopic resection for early gastric cancer (EGC).
  
  
  METHODS
  From 2005 through 2011, 961 patients with EGC were treated with endoscopic submucosal dissection (ESD). Patients were grouped as standard and expanded criteria, while those who did not meet the expanded criteria were regarded as the group beyond the expanded criteria. Complete resection rate and the long-term clinical outcomes were compared among the three groups.
  
  
  RESULTS
  Complete resection rate was significantly higher in the standard group than in expanded and beyond the expanded group; 96.1% for standard, 92.5% for expanded, 55.5% for beyond the expanded indication group. During a mean follow-up of 42 months, local tumor recurrence developed more frequently in beyond the expanded group (7.8%) than in the standard and expanded group (1.8%). Metachronous cancer incidence (6.5%) did not differ significantly between the three groups. Two-thirds of recurred or metachronous tumors were treated with additional ESD. Lymph node metastasis developed in 0.6%. Five-year overall survival rate was 94.8% (96.6% for standard, 94.2% for expanded, 84.4% for beyond expanded, P < 0.001) and disease-free survival rate was 99.1% (100, 99.3, 92.8%, respectively, P < 0.001).
  
  
  CONCLUSIONS
  Endoscopic resection for EGC showed favorable long-term clinical outcomes in the patients within the standard and expanded criteria, whereas less favorable clinical outcomes in the patients beyond the expanded criteria.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Yongun-dong 28, Chongno-gu, Seoul, 110-744, South Korea, doct00@hanmail.net.
authors.forename: Jeongmin
authors.initials: J
authors.lastname: Choi
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004210:Dissection; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000473:pathology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome