---
title: "Endoscopic submucosal dissection versus surgery for early gastric cancer in patients ≥75: systemat"
id: "pubmed-42763214"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42763214"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42763214/"
doi: "10.3760/cma.j.cn112137-20260326-00815"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Endoscopic submucosal dissection versus surgery for early gastric cancer in patients ≥75: systemat
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42763214
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42763214/)
- **DOI:** [10.3760/cma.j.cn112137-20260326-00815](https://doi.org/10.3760%2Fcma.j.cn112137-20260326-00815)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review and meta-analysis compared **endoscopic submucosal dissection (ESD)** with surgical resection for early gastric cancer (EGC) in patients aged 75 years and older. - The authors searched PubMed, Embase, Cochrane Library, and CNKI through April 2026 and applied standard screening and quality assessment (Newcastle-Ottawa Scale) with two independent reviewers. - Six studies totaling 2,045 patients were included: 988 in the ESD group and 1,057 in the surgery group. - Key outcomes: 5-year survival, gastric cancer recurrence rate, recurrence-related mortality rate, and tumor incidence by mucosal layer. - The pooled 5-year survival rate was higher in the **ESD** group (82.9% vs 77.4%; OR 1.29, 95% CI 1.01–1.65; P = 0.040; I2 = 0). - The pooled gastric cancer recurrence rate was higher after **ESD** (8.5% vs 4.3%; OR 2.39, 95% CI 1.37–4.14; P = 0.002; I2 = 24%). - Recurrence-related mortality was lower in the **ESD** group (1.9% vs 4.9%; OR 0.47, 95% CI 0.25–0.86; P = 0.020; I2 = 34%). - Subgroup analysis by mucosal layer showed more mucosal tumors in the **ESD** group (78.8% vs 38.3%; OR 3.40, 95% CI 1.15–10.07; P = 0.030; I2 = 95%) and fewer submucosal tumors (20.7% vs 61.4%; OR 0.29, 95% CI 0.10–0.87; P = 0.030; I2 = 95%). - Publication bias assessment (funnel plot) suggested approximate symmetry; sensitivity analysis (leave-one-out) showed only slight fluctuations around the pooled estimate (log OR = 1.05). - The authors conclude that for patients aged ≥75 with EGC, **ESD** demonstrates superior clinical efficacy and safety compared with surgery based on pooled data from the included studies.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliation * 1 Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China. * PMID: **42763214** * DOI: [ 10.3760/cma.j.cn112137-20260326-00815 ](https://doi.org/10.3760/cma.j.cn112137-20260326-00815) Item in Clipboard Meta-Analysis # [Efficacy and safety of endoscopic submucosal dissection versus surgery for early gastric cancer in patients aged 75 years and above: a systematic review and meta-analysis] [Article in Chinese] H K Chang et al. Zhonghua Yi Xue Za Zhi. 2026. Show details Display options Display options Format Abstract PubMed PMID Zhonghua Yi Xue Za Zhi Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Zhonghua+Yi+Xue+Za+Zhi%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Zhonghua+Yi+Xue+Za+Zhi%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42763214/) . 2026 Sep 22;106(35):3790-3797. doi: 10.3760/cma.j.cn112137-20260326-00815. ### Authors [H K Chang](https://pubmed.ncbi.nlm.nih.gov/?term=Chang+HK&cauthor_id=42763214)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763214/#short-view-affiliation-1 "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China."), [X Ji](https://pubmed.ncbi.nlm.nih.gov/?term=Ji+X&cauthor_id=42763214)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763214/#short-view-affiliation-1 "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China."), [Q Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+Q&cauthor_id=42763214)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763214/#short-view-affiliation-1 "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China."), [P Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+P&cauthor_id=42763214)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763214/#short-view-affiliation-1 "Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China.") ### Affiliation * 1 Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China. * PMID: **42763214** * DOI: [ 10.3760/cma.j.cn112137-20260326-00815 ](https://doi.org/10.3760/cma.j.cn112137-20260326-00815) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42763214/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42763214/#zho-abstract) **Objective:** To systematically evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) versus surgical resection for early gastric cancer (EGC) in patients aged 75 years and above. **Methods:** A systematic search was conducted in PubMed, Embase, Cochrane Library, and CNKI from the inception of the database to April 2026, to include relevant literature on ESD and surgery for aged 75 years and above patients with EGC. The experimental group consisted of patients aged≥75 years treated with ESD (ESD group), while the control group included those treated with surgery (surgery group). According to inclusion and exclusion criteria, two researchers independently performed literature screening, data extraction using the Newcastle-Ottawa Scale, and conducted meta-analysis using RevMan 5.4 and Stata 18.0 software to assess heterogeneity using _I_ 2. Outcome measures included the 5-year survival rate, recurrence rate, recurrence-related mortality rate, and tumor incidence rates across different mucosal layers in both groups of patients. Funnel plots and leave-one-out analysis were adopted for publication bias analysis and sensitivity analysis. **Results:** A total of 6 studies involving 2 045 patients were included, with 988 in the ESD group and 1 057 in the control group. The 5-year survival rate (82.9% vs 77.4%, _OR_ =1.29, 95%_CI_ : 1.01-1.65, _P_ =0.040, _I_ 2=0) and gastric cancer recurrence rate (8.5% vs 4.3%, _OR_ =2.39, 95%_CI_ : 1.37-4.14, _P_ =0.002, _I_ 2=24%) were higher in the ESD group than those in the surgical group, whereas the recurrence-related mortality rate was lower in the ESD group (1.9% vs 4.9%, _OR_ =0.47, 95%_CI_ : 0.25-0.86, _P_ =0.020, _I_ 2=34%). Subgroup analysis by tumor incidence rates across different mucosal layers showed that the proportion of mucosal tumors was higher in the ESD group than that in the surgical group (78.8% vs 38.3%, _OR_ =3.40, 95%_CI_ : 1.15-10.07, _P_ =0.030, _I_ 2=95%), whereas the proportion of submucosal tumors was lower in the ESD group than in the surgical group (20.7% vs 61.4%, _OR_ =0.29, 95%_CI_ : 0.10-0.87, _P_ =0.030, _I_ 2=95%). Funnel plot analysis showed that the studies were generally symmetrically distributed on both sides of the pooled effect size (log _OR_), forming an inverted funnel shape; sensitivity analysis demonstrated that the point estimates of individual studies fluctuated slightly around the original pooled effect size (log _OR_ =1.05). **Conclusion:** For EGC patients aged 75 years and above, ESD demonstrates superior clinical efficacy and safety compared to surgical treatment. **目的：** 系统评价内镜黏膜下剥离术（ESD）与外科手术治疗75岁及以上早期胃癌（EGC）患者的临床疗效及安全性。 **方法：** 系统检索PubMed、Embase、Cochrane Library、中国知网数据库，检索时限为建库至2026年4月，纳入采用ESD与外科手术治疗75岁及以上EGC患者的相关文献。试验组（ESD组）为采用ESD治疗75岁及以上EGC患者，对照组（外科手术组）为采用外科手术治疗75岁及以上EGC患者。2名研究者按照纳入与排除标准独立筛选文献和提取资料，采用纽卡斯尔-渥太华量表评估纳入文献的质量，应用RevMan 5.4和Stata 18.0软件进行meta分析，以 _I_ 2评估异质性。结局指标为两组患者的5年生存率、胃癌复发率、复发相关致死率及不同黏膜层面的肿瘤发生率。采用漏斗图和逐一剔除法进行发表偏倚分析与敏感性分析。 **结果：** 共纳入6篇文献2 045例患者，其中ESD组988例，对照组1 057例。ESD组5年生存率（82.9%比77.4%， _OR_ =1.29，95%_CI_ ：1.01~1.65， _P_ =0.040， _I_ 2=0）、胃癌复发率（8.5%比4.3%， _OR_ =2.39，95%_CI_ ：1.37~4.14， _P_ =0.002， _I_ 2=24%）均高于外科手术组；复发相关致死率低于外科手术组（1.9%比4.9%， _OR_ =0.47，95%_CI_ ：0.25~0.86， _P_ =0.020， _I_ 2=34%）。不同黏膜层面的肿瘤发生率的亚组分析显示，ESD组黏膜层肿瘤发生率高于外科手术组（78.8%比38.3%， _OR_ =3.40，95%_CI_ ：1.15~10.07， _P_ =0.030， _I_ 2=95%）；而黏膜下层肿瘤发生率低于外科手术组（20.7%比61.4%， _OR_ =0.29，95%_CI_ ：0.10~0.87， _P_ =0.030， _I_ 2=95%）。漏斗图提示各研究在合并效应量（log _OR_ ）两侧整体基本对称分布，呈倒漏斗状分布；敏感性分析显示各研究的效应点估计值均在合并效应量（log _OR_ =1.05）附近微幅波动。 **结论：** 对于75岁及以上EGC患者，ESD治疗的疗效及安全性优于外科手术。. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 所有作者声明不存在利益冲突 ## Similar articles * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ Updated evaluation of endoscopic submucosal dissection versus surgery for early gastric cancer: A systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/31783166/) Liu Q, Ding L, Qiu X, Meng F.Liu Q, et al.Int J Surg. 2020 Jan;73:28-41. doi: 10.1016/j.ijsu.2019.11.027. Epub 2019 Nov 26.Int J Surg. 2020.PMID: 31783166 * [ Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/31874864/) Tao M, Zhou X, Hu M, Pan J.Tao M, et al.BMJ Open. 2019 Dec 23;9(12):e025803. doi: 10.1136/bmjopen-2018-025803.BMJ Open. 2019.PMID: 31874864Free PMC article. * [ [Efficacy comparison between surgical resection and endoscopic submucosal dissection of early gastric cancer in a domestic single center]. ](https://pubmed.ncbi.nlm.nih.gov/29492919/) Rong L, Cai Y, Nian W, Wang X, Liang J, He Y, Zhang J.Rong L, et al.Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Feb 25;21(2):190-195.Zhonghua Wei Chang Wai Ke Za Zhi. 2018.PMID: 29492919Chinese. * [ [Comparison of long-term outcomes between endoscopic submucosal dissection and surgical resection for early gastric cancer with undifferentiated histology]. ](https://pubmed.ncbi.nlm.nih.gov/34000770/) Zhang QR, Guo CG, Zhang YM, Xue LY, He S, Dou LZ, Liu Y, Shi L, Zhao DB, Wang GQ.Zhang QR, et al.Zhonghua Wei Chang Wai Ke Za Zhi. 2021 May 25;24(5):413-419. doi: 10.3760/cma.j.cn.441530-20200402-00179.Zhonghua Wei Chang Wai Ke Za Zhi. 2021.PMID: 34000770Chinese. 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