A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer
Authors: Singh Rajesh K. 
Published: October 2023

<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; background: white;">Background:</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; background: white;">We conducted a meta-analysis to assess the impact</span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;"> of gastrectomy versus endoscopic submucosal dissection for early stomach cancer.</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">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.</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">Methods:</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">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. </span><span lang="EN-GB" style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">Odds ratio (OR), and mean difference (MD)</span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;"> with 95% confidence intervals (CIs) were calculated </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">to assess the effect of the gastrectomy versus endoscopic submucosal dissection for early stomach cancer </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">by the </span><span lang="EN-GB" style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">dichotomous, and contentious </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">methods with a random or fixed effect model.</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">Results:</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survivals (OR, 0.59; 95% CI, 0.45-0.77, p&lt;0.001), lower the 5-year overall survival in propensity score-matched patients (OR, 0.49; 95% CI, 0.41-0.59, p&lt;0.001), higher recurrences (OR, 6.99; 95% CI, 5,03-9.70, p&lt;0.001), and higher synchronous lesion (OR, </span><span dir="RTL" style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">7</span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">.24; 95% CI, 2.78-18.83, p&lt;0.001), and higher metachronous lesion (OR,10.05; 95% CI, 6.44-15.67, p&lt;0.001) compared to the gastrectomy for early stomach cancer.</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">However, no significant difference was found between submucosal dissection and gastrectomy for early stomach cancer </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">in </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">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-</span><span dir="RTL" style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">1</span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">.16, p=0.10),</span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;"> and </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">disease-specific survival (OR, 1.05; 95% CI, 0.38-2.89, p=0.92).</span></p>
<p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi;">Conclusions:</span></p>
<p><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: PMingLiU; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">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 </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">in </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: PMingLiU; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">recurrence-free survival, disease-free survival,</span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;"> and </span><span style="font-size: 10.0pt; font-family: 'Arial',sans-serif; mso-ascii-theme-font: minor-bidi; mso-fareast-font-family: PMingLiU; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">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.</span></p>