Comparison of long-term outcomes between endoscopic submucosal dissection and surgery on treatment of early esophagogastric junction adenocarcinoma

Objective To evaluate the long-term efficacy of endoscopic submucosal dissection (ESD) and surgical resection on the treatment of early esophagogastric junction (EGJ) adenocarcinoma. Methods A retrospective analysis was performed on the data of 166 consecutive cases with early EGJ adenocarcinoma in Digestive Endoscopy Center and Department of General Surgery of Shanxi Provincial People′s Hospital from January 2004 to June 2018. Their preoperative assessment conformed to the absolute and expanded criteria of ESD, and postoperative pathological assessment accorded with the absolute and expanded criteria of curative resection. Patients were divided into the ESD group (n=77) and the surgical resection group (n=89), and the recent results (curative resection rate and complications) and long-term results (cumulative survival rate) were compared between the two groups. Results In the ESD group, 65 (84.4%) patients met the absolute criteria of ESD treatment and 12 (15.6%) patients met the expanded criteria. In the surgical resection group, 60 (67.4%) patients met the absolute criteria of ESD and 29 (32.6%) patients met the expanded criteria. The difference in the composition of ESD criteria was statistically significant between the two groups (P=0.011). Other baseline indicators showed no significant difference between the two groups (P > 0.05). In the ESD group, the overall resection rate was 98.7% (76/77), the complete resection rate was 94.8% (73/77), and the curative resection rate was 93.5% (72/77). In the surgical resection group, the curative resection rate was 100.0% (89/89). The difference in the curative resection rate between the two groups was not statistically significant (P=0.05). In the ESD group, there were 3 (3.9%) cases of intraoperative bleeding, 1 (1.3%) case of early postoperative bleeding, and 2 (2.6%) cases of intraoperative perforation. In the surgical resection group, there was 1 (1.1%) case of intraoperative bleeding, 4 (4.5%) cases of postoperative bleeding, and 2 (2.2%) cases of postoperative anastomotic leakage. There was no death or local recurrence occurred in the both groups within 1 month after treatment. The median follow-up time was 89.3 months (ranged 72.5-105.7 months) in the ESD group and 82.3 months (ranged 69.6-101.0 months) in the surgical treatment group, respectively. There was no tumor-related death or recurrence occurred in the two groups during follow-up. The 5-year survival rate in the ESD group and the surgical resection group was 94.8% (73/77) and 96.6% (86/89), respectively. The difference in the cumulative survival rate was not significant between the two groups (P=0.648). Subgroup analysis showed that there was no significant difference in the cumulative survival rate between patients receiving ESD and those receiving surgical resection who met the absolute criteria of ESD (P=0.449) and met ESD expanded criteria (P=0.505). Conclusion For EGJ adenocarcinoma conforming to the ESD treatment absolute and expanded criteria, ESD may be an alternative treatment option to surgery with the comparable long-term outcomes. Key words: Gastrectomy; Endoscopic submucosal dissection; Esophagogastric junction; Early adenocarcinoma; Long-term outcomes