title: Endoscopic submucosal dissection versus surgical resection for early gastric cancer: a retrospective multicenter study on immediate and long-term outcome over 5 years.
abstract: Endoscopic submucosal dissection (ESD) is an alternative to surgical resection for treating early gastric cancer (EGC). However, there have been limited reports on the long-term outcome of ESD compared to that of surgical resection. The aim of this study was to evaluate the immediate and long-term clinical and oncologic outcomes of ESD compared to surgical resection.
  
  
  
  We retrospectively reviewed data of patients in five centers who were treated with ESD or surgical resection for EGC within expanded criteria for ESD from 2006 to 2008.
  
  
  
  ESD group had significantly shorter procedure times, shorter fasting period, and shorter hospital stay than the surgical resection group. Immediate complications in the surgical resection group were more common compared to those in the ESD group. Five-year cancer recurrence rate of the ESD group was 12.3 % and significantly higher than 2.1 % of the surgical resection group (P = 0.001). Five-year disease-free survival rate of the surgical resection group was 97 %, which was significantly higher than 85 % of the ESD group (P = 0.001). Metachronous lesions were equally found every year during the follow-up period in the ESD group. Five-year overall survival rates were 100 % for both groups.
  
  
  
  ESD might be an acceptable and effective treatment for EGC considering overall survival rates with fewer early complication rates and shorter duration of hospital stay compared to surgical resection. However, intensive and persistent endoscopic surveillance should be performed after ESD for early detection of metachronous lesions.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Seung Jee
authors.initials: SJ
authors.lastname: Ryu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea. bleok@dreamwiz.com.
authors.forename: Byung-Wook
authors.initials: BW
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Boo Gyeong
authors.initials: BG
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Ji Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
authors.forename: Joon Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Jin Il
authors.initials: JI
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Jae-Myung
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of General Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Jin-Jo
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of General Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Seung-Man
authors.initials: SM
authors.lastname: Park
authors.affiliation: Department of General Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Cho Hyun
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of General Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Song
authors.affiliation: Department of General Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Jun Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of General Surgery, St. Paul's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Sung Geun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Department of General Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of General Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Wook
authors.initials: W
authors.lastname: Kim
mesh_terms: D000368:Aged; D004210:Dissection / Q000379:methods; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Gastric cancer; Surgical resection