Impact of preceding noncurative endoscopic submucosal dissection on patients with early gastric cancer who undergo subsequent surgery: a meta-analysis

ABSTRACT

Background

The influence of preceding noncurative endoscopic submucosal dissection (ESD) on the efficacy of subsequent surgery is still controversial among early gastric cancer (EGC), especially for laparoscopic gastrectomy. The present meta-analysis was conducted to compare clinical outcomes between patients with EGC who underwent noncurative ESD before surgery (ESD group) and those who underwent direct surgery (non-ESD group).

Methods

Related databases were searched, and articles comparing differences between ESD and non-ESD groups were included for meta-analysis.

Results

Ten retrospective studies with 3465 participants were included in this meta-analysis. Compared with the non-ESD group, the ESD group was older and had more males, smaller tumors, more differentiated tumors and a higher proportion of pT1b, a shorter operation time, fewer dissected lymph nodes, a lower rate of positive lymph nodes and a lower rate of D2 dissection. There was no significant difference in intraoperative blood loss, postoperative complication rate, postoperative hospital stay or long-term prognosis, etc.

Conclusion

Preceding noncurative ESD has no negative impact on the short- and long-term results of additional gastrectomy (open surgery or laparoscopic surgery).

KEYWORDS:

• Early gastric cancer
• endoscopic submucosal dissection
• noncurative endoscopic resection
• additional surgery
• laparoscopic gastrectomy

Abbreviations

ESD: endoscopic submucosal dissection; ER: endoscopic resection; EGC: early gastric cancer; GC: gastric cancer; BMI: body mass index; LNM: lymph node metastasis; CI: confidence interval; df: degree of freedom; NOS: Newcastle–Ottawa quality assessment scale; WMD/OR/HR: weighted mean difference/odds ratio/hazard ratio; eCuraA: endoscopic curability A; eCuraB: endoscopic curability B; eCuraC: endoscopic curability C; UL: ulcerative findings; HM: horizontal margin; VM: vertical margin; LVI: lymphovascular infiltration.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to this research; conception and design: Jian Jiao, Han Li; analysis and interpretation of the data: Liang Shang, Huicheng Ren, Chunshui Ye; drafting of the paper or revising it critically for intellectual content: Ronghua Zhang, Kun Xiao, Kangdi Dong; final approval of the version to be published: Jin Liu, Leping Li. All authors agreed to be accountable for all aspects of the work.

Supplementary material

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Additional information

Funding

This paper was funded by Science and Technology Innovation Development Program of Jinan (No.2020019082); Key Research and Development Program of Shandong Province (No.2019JZZY010104); Special Foundation for Taishan Scholars Program of Shandong Province (No.ts20190978).