title: Long-term outcome of endoscopic submucosal dissection is comparable to that of surgery for early gastric cancer: a propensity-matched analysis.
abstract: BACKGROUND
  Data concerning the long-term outcomes of endoscopic submucosal dissection (ESD) versus surgery for early gastric cancer (EGC) are limited. We aimed to compare the long-term outcomes of ESD and surgery for patients with EGC.
  
  
  METHODS
  Data were reviewed from patients treated by ESD or surgery for EGC in 2005-2010. The primary outcome was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), disease-free survival (DFS), recurrence-free survival (RFS), treatment-related complications, and hospital stay duration.
  
  
  RESULTS
  Among 617 patients, 342 underwent ESD and 275 underwent surgery. The 5-year OS rates were similar between the ESD group and the surgery group (96.9% vs 98.1%, P = 0.581). In a propensity-score-matched analysis of 117 pairs, there were no significant differences in the OS rates (96.5% vs 99.1%, P = 0.125) and DSS rates (100% vs 99.1%, P = 0.317) between the ESD group and the surgery group. The ESD group had a significantly lower DFS rate (90.3% vs 98.0%, P = 0.002), a significantly lower RFS rate (95.1% vs 98.0%, P = 0.033), a significantly higher early complication rate (6.7% vs 1.5%, P < 0.001), a significantly lower late complication rate (0% vs 9.1%, P < 0.001), and a significantly shorter median hospital stay (3 days vs 10 days, P < 0.001) than the surgery group.
  
  
  CONCLUSIONS
  ESD and surgery have comparable OS rates in patients with EGC. ESD has benefits, including a lower late complication rate and shorter hospital stay. However, RFS and DFS rates might be lower after ESD than after surgery.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 602-739, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 602-739, Korea. doc0224@pusan.ac.kr.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 602-739, Korea.
authors.forename: Bong Eun
authors.initials: BE
authors.lastname: Lee
authors.affiliation: Department of Pathology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 602-739, Korea.
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
authors.affiliation: Department of Surgery, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Jeon
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D018572:Disease-Free Survival; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome
keywords: Early gastric cancer; Endoscopic submucosal dissection; Gastrectomy; Survival