| Objective:Early gastric cancer(EGC)is defined as a lesion or carcinomathat is limited to the mucosa or submucosa,regardless of lymph node involvement in 1962 based on the Japan Endoscopy Society.Endoscopic resection(ER)is a alternative treatment for differentiated early gastric cancer(EGC)without lymph node metastasis.Radical gastrectomy is the standard treatment method for EGC.Accumulated pathologic data of surgically resected EGC specimens has shown that most patients with EGC do not show any accompanying lymph node metastasis.Surgical gastrectomy with lymph node dissection is not always necessary for all patients.But its relative benefits and risks are unclear.This systematic review was designed to investigate the efficacy and safety of endoscopic resection(ER)for the treatment of early gastric cancer(EGC).Method:PubMed,EMBASE,Ovid,EBSCO,The Cochrane Library,Web of Science,CBM,CNKI,WanFang and Vip were electronically searched for relevant studies comparing endoscopic resection and surgery for EGC from 1984 through February 2017.Search strategy:#1.early stomach neoplasms OR early gastric cancer #2.endoscopic therapy #3.endoscopic resection #4.endoscopic mucosal resection #5.endoscopic submucosal dissectionsurgical #6.procedures,operative OR general surgery OR surgery #7.Laparoscopic surgery #8.digestive system surgical procedures OR gastrointestinal surgery #9.radical operation for carcinoma of stomach #10.gastrectomy#11.2 OR 3 OR 4 OR 5 #12.6 OR 7 OR 8 OR 9 OR 10 #13.1 AND 11 AND 12 in PubMed with title/abstract restriction.Two reviewers independently screened literature,extracted data.Then,RevMan 5.3 software was used for meta—analysis.The standardized mean difference(SMD)was recommended for continuous data,and the relative risk(RR)or The risk difference(RD)with 95 % confidence intervals(CI)was recommended for dichotomous data and survival analysis data.Statistical heterogeneity between trials was evaluated by the Chi square test and was considered to be present when P was less than 0.10.We also used I2 to assess the heterogeneity.An I2 of more than 50 % was considered to be statistically significant.In the presence of statistical heterogeneity,heterogeneity was explored by subgroup analysis or a randomeffects model.Whereas a fixed-effects model was applied when there was no statistical heterogeneity between studies.Publication bias was detected by a funnel plot.The primary endpoint was DFS = disease-free survival,DSS = disease-specific survival,OS = overall survival,RFS = recurrence-free survival.The secondary endpoints were Local Recurrence,procedure-related death,Metachronous Lesions,Hospital Stay,Procedure-Related Complication,Operation Time and Cost.Result:A total of 4398 potential studies were generated through our search strategy.80 potentially appropriate articles were selected for further screening after excluding duplicates and unrelated studies.Thus,the remaining 14 studies,including 3120 patients in the ER group and 1552 patients in the SR group,were eligible for the meta-analysis.All included studies were cohort study and were conducted in Asian countries,including China,Japan,and Korea.Eleven studies consisting of a total of 4672 patients were identified and selected for evaluation.Meta-analysis showed that long-term outcomes of ER versus SR for EGC were comparable in terms of 5-year OS risk ratio [RR] 1.01,95% confidence interval [CI](0.99-1.03),5-yearDSS RR 0.98,95% CI(0.89-1.08),5-yearDFS RR 0.92,95% CI(0.84-1.01),and 5-yearRFS RR 0.98,95% CI(0.94-1.01).ER had shorter operation time,hospital stay SMD-2.27,95% CI(-3.40 to-1.13),lower costs,and fewer procedure-related complications RR 0.41,95% CI(0.28–0.61)compared to SR.However,ER had higher incidences of local recurrence risk difference RD 0.01,95% CI(0.00–0.02)and metachronous lesions RR 7.17,95% CI(3.65–14.08).Conclusion:Compared with SR for EGC treatment,ER was associated with similar long-term outcomes and considerable advantages concerning procedurerelated complications,operation time,hospital stay,and cost,but was also associated with disadvantages such as higher incidence of local recurrence and metachronous lesions. |
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