Comparison Of Endoscopic Submucosal Dissection With Radical Surgery For Treatment Of Early Gastric Cancer

Background and ObjectiveGastric cancer is one of the most common malignant tumors for human beings,ranking the fourth in terms of global tumor incidence.It is also the second death causes of tumor.Due to the lack of understanding of early gastric cancer lymph node metastases in the past,it has been believed for a long period of time that only through the radical surgery by cleaning the regional lymph nodes,can we reach the purpose of curative resection of early gastric cancer.With the rapid development of gastrointestinal endoscopy technology,as well as the deeper understanding of early gastric cancer pathological physiology,there has been a significant progress in the endoscopic treatment for early gastric cancer.Among a great number of emerging endoscopic techniques,endoscopic submucosal dissection(ESD)is one of the best treatments for early gastrointestinal tumors.There has accumulated a huge amount of clinical experience for ESD during its rapid development in last 20 years.Although it has been confirm that radical surgery for the treatment early gastric cancer has a definite therapeutic effect,reflected by a low postoperative recurrence rate,it also accompanied with some disadvantages such as surgical trauma,relatively slow postoperative recovery,more intraoperative and postoperative complications,higher hospitalization expense and lower postoperative quality of life.For those early gastric cancer patients who have a negligible risk of lymph node metastasis,ESD is thought to be a safe and effective treatment.ESD enjoys the advantages of fast recovery,less complications and better quality of life for patients.The goal of this study is to elucidate if endoscopic submucosal dissection was superior to radical surgery in operation related factors,postoperative overall quality of life,mental state and sleep quality,as well as to explore the rational treatment for early gastric cancer,and to provide clinical evidence for clinicians for chosing different treatment methods for early gastric cancer.MethodsRetrospective analysis was carried out from March 2012 to 2015 September in the digestive endoscopy center of Ji’nan Central Hospital Affiliated To Shandong University.Eighty-six patients with early gastric cancer entered into the ESD group,72 patients were divided into the radical surgery group.The basic data as well as the medical information data of the research objects were collected and analysed.Questionnaires such as Quality of life index(QL-Index),The Chinese versions of the European Organization for Research and Treatment of Cancer(EORTC),Quality of Life Questionnaire Core 30(QLQ-C30),Hospital Anxiety and Depression Scale(HADS)and Pittsburgh Sleep Quality Index(PSQI)were finished and analysed.Statistical analysis was performed using the SPSS 20.0 software.Comparison of measurement data were carried out using t test,while for count data,chi-square test was used for comparison.P<0.05 indicates statistical differences.ResultsESD group were less than that in the radical surgery group in operation time,total hospitalization expense and length of stay in hospital(P<0.001).There were no significant differences in delayed postoperative hemorrhage and perforation between the two groups(P>0.05).ESD group was significantly lower than radical surgery group in the incidence of fever(P<0.001).In the total scores(overall scores)and sub group scores of QL-Index and QLQ-C30,ESD group were significantly higher than that of radical surgery group(P<0.05).ESD group were significantly lower than the radical surgery group in HADS and PSQI scores(P<0.05).ConclusionCompared with radical surgery,ESD has advantages in terms of postoperative complications,patient’s quality of life,operation time,postoperative hospital stay,medical expenses in the treatment of early gastric cancer.