Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2192
Peer-review started: August 7, 2020
First decision: December 3, 2020
Revised: December 16, 2020
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: April 6, 2021
Processing time: 235 Days and 5.2 Hours
Controversy exists about the benefit of additional surgery after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).
Whether patients who do not meet the criteria for curative resection after ESD need further surgery remains largely controversial. Therefore, factors associated with patient prognosis should be identified, which would provide predictive tools for clinical decisions.
This study aimed to assess the risk factors for overall survival (OS) upon additional surgery in patients with EGC who initially underwent ESD, especially the impacts of lymph node metastasis and residual tumor.
Patients were retrospectively assessed, evaluating OS as the primary outcome, and lymph node metastasis and residual tumor as secondary outcomes. Logistic regression models and Kaplan-Meier curves were used for further analysis.
Male sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor were independently associated with OS. In the 4-81-mo follow-up period, OS was 77.0 ± 12.1 mo, and the 3-year and 5-year OS rates were 94.1% and 85%, respectively.
Male sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor are independently associated with OS in patients with EGC undergoing additional surgery after ESD.
Compared with surgery, ESD could be a safe and effective treatment for some EGC patients to some extent. Nevertheless, additional radical surgery must be considered on a case-by-case basis in order to maximize the radical resection of the tumor and improve long-term prognosis.