Long term outcomes comparing between endscopic mucosal resection and traditional gastrectomy for treatment of early gastric cancer

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Aims The purpose of this study was to confirm whether the endoscopical mucosal resection for early gastric replace to the traditional gastrectomy on the view point of long term patients outcomes.Methods Among consecutive series of 1298 patients with early gastric cancer (EGC), a total of 214 cases with EGC endoscopically resected from May 1989 and December 2001 were included in the study. Among them 26 patients (11.6%) underwent additional EMR followed by surgery, because of the residual cancer, and they received 17 distal gastrectomy (DG), 7 proximal gastrectomy (PG), and 2 total gastrectomy (TG). The rest 188 patients were received EMR only and were followed without gastrectomy. Eight hundred fifteen patients received DG, 135 PG, 107 TG, 11 wedge-resection of the stomach and 5 resection of the rest stomach between July 1975 and December 2001. Between July 1975 and April 1989, 369 patients received distal gastrectomy (DG), 30 proximal gastrectomy (PG), 52 total gastrectomy (TG), 2 wedge-resection of the stomach and 2 resection of the rest stomach.Results Ten-year survival rates of patients underwent distal G, PG, TG, wedge-resection, resection of the rest stomach, and EMR were, 81.1%, 70.4%, 52.0%, 42.1%, 0%, and 49.2%, respectively. There were significant differences between DG and EMR (log rank test, p<0.0001).Among mucosal cancer patients 18/500(3.6%), 1/66(1.5%), 1/48(2.1%), and 1/183(0.5%) who received DG, PG, TG, and EMR were disease specific death in this analysis. Among submucosal cancer patients, 14/335(4.2%), 0/76(0%), 5/59(8.5%), and 1/15(6.7%) who received DG, PG, TG, and EMR were disease specific death.Comparing to the patients between receiving EMR alone, and gastrectomy after EMR, and between indicated ERM patients by criteria of the Japanese Gastroenterology Endoscopy Society and no-indicated patients, the former was better outcome than the latter, and also showed to not be better than those with distal gastrectomy.Conclusions The outcome of patients who received EMR were not better than those who received distal gastrectomy, however, it is important to treat with minute and small cancer patients such as early cancer by endoscopy on the view point of patients QOL. From our results doctors who treat cancer patients by endoscopy, must guide the important of the restriction of diet in cancer patients, which is not correlate to cure cancer, but to patients good QOL as well as persons without cancer.

Long term outcomes comparing between endscopic mucosal resection and traditional gastrectomy for treatment of early gastric cancer

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