Long-term outcomes of additional surgery versus non-gastrectomy treatment for early gastric cancer after non-curative endoscopic submucosal dissection: a meta-analysis  

作　　者：Sixuan Li Xueli Tian Jingyao Wei Yanyan Shi Hua Zhang Yonghui Huang 

机构地区：[1]Health Science Center,Peking University,Beijing 100191,China [2]Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China [3]Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China

出　　处：《Chinese Medical Journal》2023年第5期528-535,共8页中华医学杂志（英文版）

基　　金：National Natural Science Foundation of China(No.82070653)

摘　　要：Background:Endoscopic resection is increasingly used in the treatment for early gastric cancer(EGC);however,about 15%of endoscopic submucosal dissection(ESD)cases report non-curative resection.The efficacy of different remedial interventions after non-curative ESD for EGC remains controversial.This meta-analysis aimed to compare the long-term outcomes of additional surgery and non-gastrectomy treatment for EGC patients who underwent non-curative ESD.Methods:All relevant studies published up to October 2021 were systematically searched in the PubMed,Web of Science,and Embase databases.The medical subject headings terms"early gastric cancer,""gastrectomy,""endoscopic submucosal dissection,"and their related free keywords were used to search relevant articles without restrictions on regions,publication types,or languages.The Newcastle–Ottawa Quality Assessment Scale was used to evaluate the quality of the included studies.Odds ratios(ORs)with 95%confidence intervals(CIs)of 5-year overall survival(OS),disease-specific survival(DSS),disease-free survival(DFS)and hazard ratios(HRs)with 95%CIs of OS were calculated using a random-or fixed-effects model.Results:This meta-analysis included 17 retrospective cohort studies with 5880 patients,of whom 3167 underwent additional surgery and 2713 underwent non-gastrectomy.We found that patients receiving additional gastrectomy had better 5-year OS(OR=3.63,95%CI=3.05–4.31),DSS(OR=3.22,95%CI=2.22–4.66),and DFS(OR=4.39,95%CI=1.78–10.82)outcomes than those receiving non-gastrectomy treatments.The pooled HR also showed that gastrectomy following non-curative ESD significantly improved OS(HR=0.40,95%CI=0.33–0.48).In addition,elderly patients benefited from additional surgery in consideration of the 5-year OS(HR=0.54,95%CI=0.41–0.72).Conclusions:Compared with non-gastrectomy treatments,additional surgery offered better long-term survival outcomes for patients with EGC who underwent non-curative ESD.

关 键 词：Endoscopic mucosal resection Stomach neoplasms Non-curative resection Additional surgery Non-gastrectomy treatment Disease-free survival 

分 类 号：R735.2[医药卫生—肿瘤]