Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication

Abstract

Background: Endoscopic submucosal dissection has become widely used for early gastric cancer withan expanded indication, although there is no strong consensus. We aimed to compare the clinical andlong-term oncological outcome after endoscopic submucosal dissection according to indication.Methods: Retrospective review of 1152 patients with 1175 lesions who had undergone endoscopic submucosaldissection for early gastric cancer at tertiary educational hospital in Korea, between March 2005and November 2011. Ofthese, 366 and 565 lesions were included in the absolute and expanded indicationgroups, respectively.Results: En bloc resection rates were not significantly different between the absolute and expandedindication groups. The complete resection rate was higher in the absolute indication group versus theexpanded indication group (94.8% vs. 89.9%, respectively; P = 0.008). In the expanded indication group,complete resection rate was higher in the differentiated versus undifferentiated tumour subgroups (92.9%vs. 78.4%, respectively; P < 0.001). Recurrence rates were 7.7% in the absolute indication group vs. 9.3% inthe expanded indication group (P = 0.524). Disease-free survival was not significantly different betweenthe two indication groups (P = 0.634).Conclusions: Endoscopic submucosal dissection for early gastric cancer with expanded indication is afeasible approach to disease management. Periodic endoscopic follow-up is necessary to detect cancerrecurrence.