title: Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection.
abstract: BACKGROUND
  Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes.
  
  
  OBJECTIVE
  To compare long-term outcomes of ER with those of surgery in patients with EGC who met the absolute indication for ER.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A specialized center for the treatment of cancer.
  
  
  METHODS
  We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size.
  
  
  METHODS
  The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score.
  
  
  RESULTS
  Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7% vs 93.6%, respectively; P = .725 by log-rank test). There were no gastric cancer-related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1%, 16/261) than in the surgery group (0.9%, 1/114) (P = .024). However, most patients (93.8%, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9% vs 2.7%, P = .028).
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Center for Clinical Trials, National Cancer Center, Goyang, Korea.
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome