Objects: Endoscopic submucosal dissection (ESD) has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer (EGC) en bloc, but long-term clinical outcomes remain unknown. We conducted a follow-up study on tumor recurrence and survival after ESD.
Design: ESD was performed for patients with EGC that fulfilled the expanded criteria.
Setting: The criteria for ESD were: mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings ≤3 cm in diameter; and minute submucosal invasive cancer ≤3 cm in size.
Patients: 551 patients with 589 EGC lesions were enrolled.
Intervention: The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6 to 89 months (median, 30 months).
Main outcome measures: Resectability (en bloc or piecemeal resection), curability (curative or non-curative), and complications were assessed, and factors related to each were analyzed statistically. The overall and disease-free survival rates were estimated.
Results: En bloc resection was achieved in 94.9% (559/589), and larger lesions were at higher risk of piecemeal resection. 550 of 581 lesions (94.7%) were deemed to have undergone curative resection. En bloc resection was the only significant contributor to curative ESD. Patients with non-curative resection developed local recurrence more frequently. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively.
Conclusion: Precise assessment of curability with successful one-piece resection may reduce tumor recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.