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
Research background

There are several surgical options for treating early gastric cancers (EGCs), such as endoscopic resection, laparoscopic or open gastrectomy. The role of endoscopic submucosal dissection (ESD) in treating EGC is not well established, especially when compared with resection surgery.

Research objectives

In this study, the authors aim to compare the safety and efficacy of the short- and long-term outcomes between ESD and resection surgery.

Research methods

The databases from January 1990 to June 2018 of PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. The 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. By using either fixed- or random-effects models depending on heterogeneity across studies, the pooling analysis was conducted.

Research results

Fourteen studies comprising 5112 patients were eligible for analysis. This meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time, shorter hospital stay, and lower postoperative complication rate. And the EGC patients who underwent ESD had higher recurrence rate than resection surgery patients. However, the long-term survival including overall survival and event-free survival showed no significant differences between these two groups.

Research conclusions

This meta-analysis suggested that ESD is safe and feasible in comparison with resection surgery in treating EGC, with clinical advantages in operation time, hospital stay, and postoperative complications. The long-term survival also supported the safety of ESD compared with resection surgery, although with some differences in tumor recurrence rate.

Research perspectives

The further multi-center and prospective randomized controlled trials with longer and standard follow-up strategies are warranted to verify the findings of the study.