title: Long-term efficacy of endoscopic submucosal dissection compared with surgery for early gastric cancer: a retrospective cohort study.
abstract: OBJECTIVE
  This study aimed to compare the outcomes of endoscopic submucosal dissection (ESD) and gastrectomy based on the two sets of indications for ESD, namely guideline criteria (GC) and expanded criteria (EC).
  
  
  METHODS
  Between January 2004 and July 2007, 213 early gastric cancer (EGC) patients were enrolled in this study. Of these patients, 142 underwent ESD, and 71 underwent gastrectomy. We evaluated the clinical outcomes of these patients according to the criteria.
  
  
  RESULTS
  The complication rates in the ESD and gastrectomy groups were 8.5% and 28.2%, respectively. The duration of hospital stay was significantly shorter in the ESD group than the gastrectomy group according to the GC and EC (p<0.001 and p<0.001, respectively). There was no recurrence in the ESD and gastrectomy groups according to the GC, and the recurrence rates in the ESD and gastrectomy groups were 4.7% and 0.0% according to the EC, respectively (p=0.279). The occurrence rates of metachronous cancer in the ESD and gastrectomy groups were 5.7% and 5.0% according to the GC (p=1.000) and 7.5% and 0.0% according to the EC (p=0.055), respectively.
  
  
  CONCLUSIONS
  Based on safety, duration of hospital stay, and long-term outcomes, ESD may be an effective and safe first-line treatment for EGC according to the EC and GC.
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Gyu Seok
authors.initials: GS
authors.lastname: Cho
authors.affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Gui Ae
authors.initials: GA
authors.lastname: Jeong
authors.affiliation: Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Han
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Yun Nah
authors.initials: YN
authors.lastname: Lee
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D061214:Patient Safety; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Gastrectomy; Indication; Long-term outcome