Long‐term outcome after endoscopic submucosal dissection for early gastric cancer: Focusing on a group beyond the expanded indication

Objective To determine the long‐term outcome after endoscopic submucosal dissection ( ESD ) in patients with early gastric cancer ( EGC ) according to the pathological extent. Methods ESD were performed in 280 patients with 309 EGC . The tumors were classified by pathological severity based on absolute indication ( AI ), expanded indication ( EI ) or beyond expanded indication ( BEI ). The therapeutic outcomes among the three groups were analyzed. Results The complete resection rates of EGC were 96.4%, 78.7% and 41.2% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P  = 0.000). En bloc resection rates were 97.6%, 87.4% and 86.3% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P  = 0.023). The 5‐year tumor recurrence rates were 1.8%, 1.5% and 15.4% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P  = 0.000). The 5‐year disease‐specific survival rates were 100%, 100% and 97.4% in the AI ‐ EGC , EI ‐ GEC and BEI ‐ EGC groups, respectively ( P  = 0.088). The 5‐year disease‐free survival rates were 98.2%, 98.5% and 84.6% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P  = 0.000). Conclusions ESD was effective and safe in treating AI ‐ EGC and EI ‐ EGC , but there was a comparatively high rate of recurrence after ESD in the BEI ‐ EGC group. However, long‐term outcomes of patients with BEI ‐ EGC that did not receive additional surgery were better than those with an natural course of EGC . Thus, ESD may be considered for specific BEI ‐ EGC patients at high risk for surgery.