Oncologic Outcomes of Endoscopic Resection for Early Gastric Cancer

Abstract

Gastric cancer is the fifth most common cancer in the world, and about one million new cases develop globally each year. Early Gastric Cancer (EGC) is a stage that tumor invades gastric mucosa or submucosa with or without involvement of the lymph nodes (LN). Endoscopic resection techniques are endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), latter of which is more popular now. Gastrectomy is the standard choice of treatment but, is highly invasive that requires longer stay at hospital, with higher costs and complication rates, especially at the anastomotic site. EMR was used more frequently before the development of ESD but, now give its popularity to ESD and EMR depends on the region and experience of the center. EMR is more convenient method for smaller lesions, associated with lower bleeding risk and shorter duration of operation compared to ESD. On the other hand, ESD has lower en-block resection rates and recurrence rates compared to EMR. In this review, we analyzed over than 10.000 patients’ oncologic outcomes including overall survival, disease free survival and recurrence rates. In conclusion, many newly diagnosed gastric cancer patients are seeking micro-invasive treatment modalities around the World for their early stage cancers. Endoscopic submucosal resection and endoscopic mucosal resection are safe and convenient procedures and had comparable oncologic outcomes with surgery. Additionally, these techniques can easily be used in patients who are not surgical candidates.