Comparison Of The Clinical And Prognosis Risk Factors Between Endoscopic Mucosal Dissection/Endoscopic Mucosal Resection And Radical Gastrectomy For Early-stage Gastric Cancer

AimCurrently,the treatment of EGC mainly focused on endoscopic surgery and radical surgical operation,but the optimal treatment of EGC was still controversial.In this paper,the clinical effects and prognostic differences of the three classical surgical methods of ESD/EMR,LARG and ORG in the treatment of EGC were studied in depth,to provide certain references for the clinical treatment of EGC.MethodA total of 457 patients with early gastric cancer(EGC)admitted to the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of University of Science and Technology of China from January 1,2014 to June 30,2017 were selected.7 patients who received chemotherapy before surgery and 32 patients who lost follow-up after surgery were excluded.A total of 417 patients were included in the study and divided into ESD/EMR group(139 cases),LARG group(108 cases)and ORG group(170 cases)according to the treatment methods.The differences in clinical efficacy,health costs and postoperative complications of the three surgical treatment methods were analyzed.The postoperative survival outcomes of patients were obtained by telephone or outpatient follow-up,and the differences in OS and DFS at 5 years were analyzed.Cox regression model was used to analyze univariate and multivariate mortality factors.Result(1).Short-term clinical efficacy:The total hospital stay for ESD/EMR group was 11 days,15 days in LARG group and 15 days in ORG group,the total hospital stay for ESD/EMR group was significantly less than that in LARG and ORG groups(P<0.05);ESD/EMR postoperative hospital stay was 6 days,10 days in LARG group and 10 days in ORG group,the ESD/EMR group was significantly less than that in surgical group(P<0.05).The mean indwelling time of the drainage tube was 0 days in the ESD/EMR group,8 days in the LARG group and 8 days in the ORG group,the ESD/EMR group was significantly less than that in the surgical group(P<0.05);Fasting was 3 days in ESD/WMR group,6 days in LARG group and 6 days in ORG group,and the fasting time was shorter in the ESD/EMR group than in the surgical group(P<0.05).In terms of gastrointestinal ventilation time,2 days after operation in ESD/EMR group,4 days in LARG group and 4 days in ORG group,which was shorter in ESD/EMR group than in LARG and ORG group(P<0.05);The time to get out of bed after surgery was 1 day in the ESD/EMR group,3 days in the LARG group,and 3 days in the ORG group,the ESD/EMR group was less than that in the other two groups(P<0.05);There were 0 lymph node dissected in ESD/EMR group,17 lymph nodes in LARG group and 16 lymph nodes in ORG group,the LARG/ORG group had obvious advantages over lymph node dissection(P<0.05);The cost of hospitalization in ESD/EMR group was 23629 yuan,49206 yuan in LARG group and 41396 yuan in ORG group,the hospitalization costs of the three groups were ranked as ESD/EMR group<ORG group<LARG group(P<0.05).(2).Surgical complications and tumor recurrence:During or after surgery,gastrointestinal bleeding,postoperative lung infection,perforation,long-term abdominal distension,incisional hernia,there were no differences among the three treatments(P>0.05);The incidence of postoperative incision infection and emaciation in the ORG group was higher than that in the ESD/EMR and LARG groups(P<0.05);There were 12 cases(8.6%)in ESD/EMR group,8 cases(7.4%)in LARG group,and 10 cases(5.9%)in ORG group in postoperative tumor recurrence with no significant difference(P>0.05).In relapsed cases,there was no difference in liver and pancreas metastasis among the three groups(P>0.05).(3).Survival outcome:By the end of follow-up,the five-year OS was 94.2%in ESD/EMR group,93.5%in LARG group,94.7%in ORG group,and the five-year DFS was 89.2%in ESD/EMR group,92.6%in LARG group,94.2%in ORG group,all showing no statistical difference(P>0.05).Survival analysis after matching propensity score showed that the 5-year OS of LARG/ORG group was 96.5%,the ESD/EMR group was 92.0%,with no significant difference(P>0.05).The 5-year DFS of LARG/ORG group was significantly better than that of ESD/EMR group.(4).Factors influencing death:Univariate analysis showed that the factors influencing EGC death were vascular invasion(P=0.01),degree of differentiation(P=0.019),lymph node metastasis(P=0.003),depth of invasion(P=0.005),and surgical method(P=0.002).Multivariate analysis showed that the main risk factors for death in EGC patients were vascular invasion(P=0.014),degree of differentiation(P=0.008),lymph node metastasis(P=0.001),depth of invasion(P=0.001),and surgical method(P=0.001).ConclusionIn the treatment of EGC,compared with ORG and LARG,ESD/EMR has the advantages of lower cost and faster postoperative recovery.However,the 5-year OS and DFS of ORG and LARG may be better than ESD/EMR after surgery.Even if EGC was in line with ESD/EMR treatment indications,there was still the risk of lymph node metastasis.Therefore,accurate clinical staging was required before surgery,which puts forward higher requirements for impact study and endoscopic ultrasonography.