Updated evaluation of additional surgery versus non-gastrectomy treatment for early gastric cancer after noncurative endoscopic resection: a meta-analysis.

BACKGROUND

Debate regarding whether additional surgery should be the preferred treatment option for patients with early gastric cancer who have undergone noncurative endoscopic resection is ongoing.

OBJECTIVES

This meta-analysis aims to provide clarity for clinicians and patients to facilitate better informed treatment decisions.

METHODS

Our meta-analysis involved searches of PubMed, Embase, and Web of Science databases. We analyzed the following prognosis-related indicators in groups receiving additional surgical or nonsurgical treatment: 5-year overall survival (OS), 8-year overall survival (OS), 5-year disease-specific survival (DSS), 5-year disease-free survival (DFS), 5-year recurrence-free survival (RFS), 5-year cancer-specific survival (CSS), and clinicopathological data.

RESULTS

After applying strict inclusion and exclusion criteria, 26 studies published in English through May 2024 were included, comprising data from 9177 patients with early-stage gastric tumors following noncurative endoscopic resection. These patients were categorized into additional surgery (n = 4903) and nonsurgical (n = 4274) groups. The following outcomes were significantly better in the additional surgery group: 5-year OS (odds ratio [OR] = 3.37, 95% confidence interval [CI] = 2.91-3.91, p < 0.00001; hazard ratio [HR] = 0.51, 95% CI = 0.41-0.64, p < 0.00001), 8-year OS (OR = 1.96, 95% CI = 1.22-3.16, p = 0.005), 5-year DSS (OR = 3.08, 95% CI = 2.08-4.55, p < 0.00001), 5-year DFS (OR = 4.17, 95% CI = 1.53-11.4, p = 0.005), 5-year RFS (OR = 9.14, 95% CI = 3.63-23.01, p < 0.00001), and 5-year CSS (OR = 2.54, 95% CI = 1.32-4.9, p = 0.005). Additionally, subgroup analysis revealed that patients over 70 years old benefitted more from surgery (OR = 3.09, 95% CI = 2.37-4.02, p < 0.00001). The results of the analysis were significant, with minimal heterogeneity.

CONCLUSIONS

Our review revealed that the prognostic indicators of patients in the additional surgery group were greater and cannot be ignored.