Early Gastric Cancer: Surgery or Endoscopy?

Abstract

Gastric cancer is an extremely important issue, responsible for the fifth leading cause of cancer death in Brazil. It has a higher incidence in men than women, but usually over 60 years of age. There is no doubt that its early detection guarantees a longer survival and, as in the literature there is still a question about the therapeutic approach of early gastric cancer, we decided to study it. The objective of this work was to perform a horizontal review of the PRISMA method to evaluate the best treatment for cases of early gastric cancer: surgery or endoscopy. Six independent reviewers placed the keywords "comparison", "submucosal endoscopic dissection", "surgical resection", "early gastric cancer", "early gastric cancer", "treatment", "surgery" and "endoscopic" in the PubMed database and obtained seventy-one articles. The inclusion criteria were adults with early gastric cancer and who underwent surgical or endoscopic laparoscopic therapy and exclusion ary patients were articles in a language other than English; Duplicate; articles that did not address the comparison between techniques of resection of early gastric cancer; articles published before 2015. Given the controversy among surgical or endoscopic therapies of early gastric cancer, the aim of this study was to analyze the revised and indexed literature in order to choose which therapy is best. After a detailed analysis of each article, nineteen of them were elected and the outcomes were as follows: in relation to the overall survival rate, among the results of the past there was a prevalence of better survival outcomes on gastrectomy, but the non-difference in the results obtained is probably due to advances in endoscopic techniques that provide lower rates of error in the procedure and greater precision in tumor removal. Regarding the adverse event rate, there was a prevalence in the results of lower rates of adverse effect on endoscopic resection (ESD) and this is probably due to the higher risk of infection that open surgery brings. Moreover, the endoscopic technique is less invasive and maintains the anatomical integrity of the stomach. Regarding the risk rate, although the result is inconclusive, it is much discussed that the risk of perforation is higher in endoscopy because it is a procedure with a lower field of surgical view. However, with advances in endoscopic technique, this risk tends to decrease as time goes by. Regarding the recurrence rate, fourteen articles obtained concrete data to conclude that recurrence rates were significantly higher in the group that underwent endoscopic resection when compared to the group submitted to gastrectomy. This is probably justified by the non-total resection of the tumor by endoscopic technique compared to gastrectomy, due to the lower visual field during the procedures and lower mobility of the surgeon. Regarding the time of hospitalization, all concluded that patients undergoing endoscopic resection had shorter hospital stay. A hypothesis for this fact would be the smaller incision in the patient and because it is a smaller surgery, having fewer adverse events with lower risk of infection, which provides a faster recovery. Finally, in relation to cost, all concluded that endoscopic resection is less costly than surgery. This is due to the fact that, because it is a smaller surgery, it requires fewer materials, anesthesia, auxiliary professionals, requires a shorter hospitalization time and has fewer adverse effects. That said, endoscopic resection proved to be more efficient in the treatment of early gastric cancer, except for the recurrence rate.