A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer

Background:

We conducted a meta-analysis to assess the impact of gastrectomy versus endoscopic submucosal dissection for early stomach cancer.

There are-now-a-variety-of-viewpoints-on-gastrectomy-versus-endoscopic-submucosal-dissection-for-early-stomach-cancer,-and-there-are-not-many-thorough-assessments-that-are-pertinent.

Methods:

A-systematic-literature-search-up-to-July-2022-was-performed-and-2456-related-studies-were-evaluated.-The-chosen-studies-comprised-15461-early-stomach-cancer-subjects-who-participated-in-the-selected-studies'-baseline-trials;-6503-of-them-used-the-endoscopic-submucosal-dissection, while 8958 used gastrectomy. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of the gastrectomy versus endoscopic submucosal dissection for early stomach cancer by the dichotomous, and contentious methods with a random or fixed effect model.

Results:

The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survivals (OR, 0.59; 95% CI, 0.45-0.77, p<0.001), lower the 5-year overall survival in propensity score-matched patients (OR, 0.49; 95% CI, 0.41-0.59, p<0.001), higher recurrences (OR, 6.99; 95% CI, 5,03-9.70, p<0.001), and higher synchronous lesion (OR, 7.24; 95% CI, 2.78-18.83, p<0.001), and higher metachronous lesion (OR,10.05; 95% CI, 6.44-15.67, p<0.001) compared to the gastrectomy for early stomach cancer.

However, no significant difference was found between submucosal dissection and gastrectomy for early stomach cancer in recurrence-free survival (OR, 0.74; 95% CI, 0.54-1.00, p=0.05), disease-free survival (OR, 0.43; 95% CI, 0.16-1.16, p=0.10), and disease-specific survival (OR, 1.05; 95% CI, 0.38-2.89, p=0.92).

Conclusions:

The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survival, lower 5-year overall survival in propensity score-matched patients, higher recurrences, higher-synchronous lesion, and higher metachronous lesion, however, no significant difference was found in recurrence-free survival, disease-free survival, and disease-specific survival compared to the gastrectomy for early stomach cancer. The small number of studies in several comparisons calls for care when analyzing the results.