The Efficacy Of Endoscopic Submucosal Dissection Versus Surgery In The Treatment Of Early Gastric Cancer:A Meta-analysis

Objective:By analyzing and comparing the efficacy of endoscopic submucosal dissection(ESD)and surgery in the treatment of early gastric cancer,to provide evidence-based basis for patients with early gastric cancer to choose endoscopic submucosal dissection.Methods:Literatures were searched through Chinese and English databases,such as Pub Med,Embase,Cochrane Library,Web of Science,Wan Fang Database and CNKI.The literatures about the efficacy comparison between endoscopic submucosal dissection and surgery in the past 10 years were searched in the above databases.Irrelevant and repetitive documents were excluded,and the quality evaluation and target data extraction were carried out for the selected documents that met the inclusion criteria.The comparative indicators included : operation time,hospital stay,integrity resection rate,curative resection rate,postoperative bleeding rate,overall complications and recurrence rate.Review Manager 5.4 software was used for statistical analysis.Results:A total of 15 literatures were included in this study,including 11 in English and4 in Chinese.The total number of patients in all literatures is 4504,including 1907 patients in ESD group and 2597 patients in surgical group.The results showed that:(1)the integrity resection rate :OR=0.16,95%CI was [0.06,0.45],and P=0.0005.The integrity resection rate of endoscopic submucosal dissection group was lower than that of surgery group.(2)the curative resection rate: OR=0.31,95%CI was [0.17,0.57],P=0.0002.The curative resection rate of endoscopic submucosal dissection group was less than that of surgical group.(3)Operation time: WMD=-81.20,95%CI was [-154.12,-8.27],P=0.03.The operation time of endoscopic submucosal dissection group was shorter than that of surgery group.(4)the hospital stay: WMD=-4.95,95%CI was [-6.50,-3.40],P < 0.00001.The hospital stay of endoscopic submucosal dissection group was shorter than that of surgical group.(5)the postoperative bleeding rate :OR=1.39,95% CI[0.54,3.60],P=0.49 > 0.05.There was no significant difference in postoperative bleeding rate between endoscopic submucosal dissection and surgery group.(6)The overall complication rate of endoscopic submucosal dissection group was lower than that of surgery group.OR=1.39,95%CI was[0.31,0.83],P=0.007.(7)the postoperative recurrence rate: OR=9.17,95%CI was[5.56,15.12],P<0.00001.The postoperative recurrence rate of endoscopic submucosal dissection group was higher than that of surgery group.Conclusion:The complete resection rate and curative resection rate of ESD group are lower than those of surgical group.The ESD group has an advantage over the surgical group in terms of shorter operative time and hospital stay.In terms of postoperative bleeding rate,there is no significant difference between ESD group and surgical group.As for the overall postoperative complications,ESD group is superior to surgical group.However,the recurrence rate of surgical group is lower than that of ESD group.ESD and surgery have their respective advantages in the treatment of early gastric cancer.Endoscopic submucosal dissection has good efficacy in the treatment of early gastric cancer.