EMR versus gastrectomy for XXXX : comparison of long-term outcomes.

@entity1 @entity204 @entity356
BACKGROUND: Limited data exist regarding the long-term outcomes of EMR compared with gastrectomy. OBJECTIVE: To compare the long-term outcomes after EMR and surgery. DESIGN: Retrospective analysis with propensity-score matching. SETTING: Tertiary care center. @entity1 : This study involved 215 @entity1 with @entity356 completely removed by EMR and 843 @entity1 who underwent curative surgical resection between January 1997 and August 2002. Propensity-score matching yielded 551 matched @entity1 . INTERVENTIONS: EMR versus surgery. MAIN OUTCOME MEASUREMENTS: Death and recurrence. RESULTS: In the matched cohort, there were no significant between-group differences in the risk of @entity204 (hazard ratio [HR] for the EMR group 1.39; 95% CI, 0.87-2.23) or recurrence (HR 1.18; 95% CI, 0.22-6.35). Although @entity1 who underwent EMR had higher risk of metachronous @entity356 (HR 6.72; 95% CI, 2.00-22.58), all recurrent or metachronous @entity356 after EMR were successfully re-treated without affecting overall survival. Although complication rates were similar (odds ratio 0.84; 95% CI, 0.41-1.70), there were no mortalities in the EMR group compared with 2 in the surgery group. The EMR group had a significantly shorter hospital stay (median 8 days, interquartile range [IQR] 6-11 days vs 15 days, IQR 12-19 days; P<.001) and lower cost of care ( 2049, IQR  1586-2425 vs  4042, IQR  3458-4959; P<.001). LIMITATIONS: Retrospective, nonrandomized study. CONCLUSIONS: EMR was comparable to surgery in terms of risk of @entity204 and recurrence. Because of its lower medical costs and shorter duration of hospital stay, EMR has advantages over surgery.
