Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2019; 11(2): 161-171
Published online Feb 15, 2019. doi: 10.4251/wjgo.v11.i2.161
Comparison of endoscopic submucosal dissection with surgical gastrectomy for early gastric cancer: An updated meta-analysis
Hua Li, Li-Qian Feng, Yao-Yao Bian, Li-Li Yang, Deng-Xiang Liu, Zhi-Bin Huo, Li Zeng
Hua Li, Li-Qian Feng, Yao-Yao Bian, Li-Li Yang, Li Zeng, School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Hua Li, Deng-Xiang Liu, Zhi-Bin Huo, Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
Author contributions: Li H, Feng LQ and Bian YY contributed equally to this work; Li H, Huo ZB and Zeng L designed the study and wrote the manuscript; Feng LQ and Bian YY conducted the literature search; Li H and Feng LQ collected and retrieved the data; Li H and Bian YY analyzed the data; Yang LL and Liu DX critically reviewed and revised the manuscript; and all authors proofed the manuscript.
Supported by Municipal Science Funds of Xingtai, No. 2015ZC202.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Li Zeng, PhD, Professor, School of First Clinical Medicine, Nanjing University of Chinese Medicine, No. 138 Xianlin Rd, Nanjing 210023, Jiangsu Province, China.
Telephone: +86-25-85811877
Received: October 16, 2018
Peer-review started: October 16, 2018
First decision: December 7, 2018
Revised: December 17, 2018
Accepted: December 23, 2018
Article in press: December 23, 2018
Published online: February 15, 2019

There are several surgical options for treating early gastric cancers (EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection (ESD) in treating EGC is not well established, especially when compared with resection surgery cases in a long-term follow-up scope.


To compare the safety and efficacy of the short- and long-term outcomes between ESD and resection surgery.


We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short- or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software (version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed- or random-effects models depending on heterogeneity across studies.


Fourteen studies comprising 5112 patients were eligible for analysis (2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference (WMD): -140.02 min, 95%CI: -254.23 to -34.82 min, P = 0.009], shorter hospital stay (WMD: -5.41 d, 95% CI: -5.93 to -4.89 d, P < 0.001), and lower postoperative complication rate [Odds ratio (OR) = 0.39, 95%CI: 0.28-0.55, P < 0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate (OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients. However, the long-term survival including overall survival [Hazard ratio (HR) = 0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival (HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.


In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the long-term survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications.

Keywords: Early gastric cancer, Endoscopic submucosal dissection, Gastrectomy, Clinical outcome, Meta-analysis

Core tip: The role of endoscopic submucosal dissection (ESD) in treating early gastric cancer (EGC) is not well established, especially when compared with resection surgery cases in a long-term follow-up scope. This study collected and analyzed up-to-date clinical data of comparison between ESD and surgical gastrectomy in EGC patients. The results turned out a comparable short- and long-term result between these two groups with more favorable short-term recovery in ESD patients.