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Comparison of long-term clinical outcomes between endoscopic and surgical resection for early-stage adenocarcinoma of the esophagogastric junction

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Abstract

Background

The aim of this study was to analyze long-term clinical and oncologic outcomes in patients with early-stage adenocarcinoma of the esophagogastric junction (AEG) managed with either endoscopic resection (ER) or surgery.

Methods

The inclusion criteria were AEG, meeting classic or expanded indications for ER of early gastric cancer, and complete resection. A total of 66 patients with Siewert type II AEG were included (ER group, n = 38; vs. surgery group, n = 28).

Results

The mean age of the ER group was greater than that of the surgery group (mean ± SD, 66.9 ± 9.7 vs. 58.5 ± 10.4 years, respectively; p = 0.001). Compared to the ER group, macroscopically flat or depressed-type lesions were more common (47.4 vs. 89.3%; p = 0.001), and mean lesion size was larger in the surgery group (13.3 ± 8.4 vs. 18.6 ± 11.0 mm; p = 0.039). One intensive care unit admission and subsequent surgery-related death occurred in the surgery group (1/28 vs. 0/38 in the ER group; p = 0.424). During follow-up, recurrence was detected in both groups (4/38 vs. 1/28; p = 0.385). Overall survival and 5-year disease-free survival did not differ between the groups (93.3 vs. 92.9%; p  = 0.282 and 88.0 vs. 100.0%; p = 0.066).

Conclusions

Once complete resection is achieved in patients with AEG who met the expanded criteria for endoscopic submucosal dissection of gastric cancer, there was no significant difference in clinical outcomes between ER and surgery.

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Acknowledgements

This study was supported by a faculty research Grant of Yonsei University College of Medicine for 6-2008-0100.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-744, Republic of Korea

    Hyun Ju Kim & Hyunsoo Chung

  2. Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50-Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea

    Sung Kwan Shin, Jun Chul Park, Sang Kil Lee & Yong Chan Lee

  3. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyoung-Il Kim, Woo Jin Hyung & Sung Hoon Noh

  4. Yonsei University Graduate School of Medicine, Seoul, Republic of Korea

    Hyun Ju Kim & Hyunsoo Chung

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  1. Hyun Ju Kim
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  2. Hyunsoo Chung
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  3. Sung Kwan Shin
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  4. Hyoung-Il Kim
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  6. Sang Kil Lee
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  7. Woo Jin Hyung
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Correspondence to Hyunsoo Chung or Sung Kwan Shin.

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Disclosures

Drs. Hyun Ju Kim, Hyunsoo Chung, Hyoung-Il Kim, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Woo Jin Hyung, Sung Hoon Noh, and Yong Chan Lee have no conflicts of interest or financial ties to disclose.

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Kim, H.J., Chung, H., Shin, S.K. et al. Comparison of long-term clinical outcomes between endoscopic and surgical resection for early-stage adenocarcinoma of the esophagogastric junction. Surg Endosc 32, 3540–3547 (2018). https://doi.org/10.1007/s00464-018-6076-5

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  • DOI: https://doi.org/10.1007/s00464-018-6076-5

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