A Comparison of Endoscopic Submucosal Dissection (ESD), Laparoscopic Endoscopic Cooperative Surgery (LECS) and Open Surgery For Early Gastric Cancer (EGC): a Retrospective Study

Aims To compare perioperative outcomes and oncological clearance of ESD versus LECS and open gastrectomy (GE) for treatment of EGC.

Methods 248 patients with EGC (T1N0M0) were treated from 2006 to 2020 at Regional Cancer Hospital. 140 underwent ESD, 94 - GE and 14 received LECS with sentinel lymph node navigation (SLNN). There was no difference in age, gender or comorbidity between ESD/GE groups, but with more comorbidities in LECS group. Clinical outcomes: baseline demographics, pathology, postoperative complications, hospital stay and overall survival rate were compared.

Results GE group patients sustained longer operative time [205+/-0.01 min] compared with ESD [130.65+/-0.99 min; p < 0.001] and similar time as in LECS group [204+/-0.8 min; p > 0.01]. Median hospital stay was longer in GE than in LECS or ESD groups [18.5 vs 12.3 vs 5.0 days; p < 0.001]. We didn’t find lymph node metastasis after LECS with SLNN. There was no perioperative mortality in ESD and LECS. Complication rate was significantly higher in GE group, especially 3-5 stages of Clavien-Dindo classification (3 stage – 8 %, 5 stage – 4 %), than in ESD group (5 perforation, 7 delayed bleeding, treated endoscopically). Metachronous cancer rate was higher in ESD (10 cases – 7,1 %) than in GE group (0 cases). Recurrence rate was 3,5 % after ESD (2 cases were treated by surgery, 3 by endoscopic resection) and 0 after surgery. The overall 5-year survival rates (for patients treated until 2015) were 95 % for ESD and 82 % for GE group (P < 0.001).

Conclusions GE is still performed more frequently in Russia than ESD even for patients with EGC. In our study ESD achieved similar oncological outcomes compared with radical GE for treatment of EGC. Patients receiving ESD had better perioperative outcomes in terms of operative time, complication rate, hospital stay and survival. LECS with SLNN is a useful alternative to GE for selected patients.

Citation: Kashin S, Kraynova E, Merkulova A et al. eP83 A COMPARISON OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD), LAPAROSCOPIC ENDOSCOPIC COOPERATIVE SURGERY (LECS) AND OPEN SURGERY FOR EARLY GASTRIC CANCER (EGC): A RETROSPECTIVE STUDY. Endoscopy 2021; 53: S123.

Publication History

Article published online:
19 March 2021