Comparative analysis for clinical efficacy and life quality between endoscopic submucosal dissection and surgical treatment of patients with early gastric cancer

Abstract

Objective To compare the efficacy, safety, and the life quality of patients with early gastric cancer (EGC) between endoscopic submucosal dissection (ESD) and surgical treatment. Methods A total of 460 cases with EGC receiving endoscopic therapy or surgical treatment were collected from October 2009 to January 2015 in the Cancer Hospital, Chinese Academy of Medical Sciences. The clinical efficacy and life quality of ESD and surgical treatment for EGC patients were retrospectively analyzed. Results There were 434 cases collected in the study, including 208 cases (229 lesions) in the ESD group and 226 cases in the surgery group. For the short-term clinical outcomes of the ESD group, the hospitalization time (7.85±3.18 d VS 16.68±5.89 d, P<0.001), hospitalization cost (3 782.30±1 898.84 CNY VS 9 685.60±3 643.97 CNY, P<0.001) and complications[0(0/208) VS 6.2% (14/226), P<0.001] were statistically different compared with those of the surgery group. For the long-term clinical outcomes, there was no statistical significance on recurrence rate[0.4%(1/229) VS 0.9% (2/226), P=0.622] between the two groups. The cumulative multiple hazard probability curve showed that the ESD group had a significantly higher risk of multiple primary lesions than the surgery group (P=0.004) after the same follow-up period. In order to exclude the influence of confounding factors, COX regression model was used to control the age and other factors, and multiple primary risks of the two groups were also statistically significant (P=0.013). The health score of self-evaluation and life quality between the two groups were statistically significant (P<0.001). Conclusion For the short-term clinical outcomes, the ESD group was better than the surgery group. For the long-term clinical outcomes, multiple primary risks were higher in the ESD group than those in the surgery group, but most of the multiple primary cases were successfully treated with a second ESD. The health score of self-evaluation and life quality were better in the ESD group than those in the surgery group. Key words: Comparative study; Surgical procedures, operative; Early gastric cancer; Endoscopic submucosal dissection; Recurrence; Quality of life