Early gastric cancer: Endoscopic resection compared with gastrectomy and survival outcomes

Abstract

Early gastric cancer presents a treatment dilemma because oncologic cure may be achieved either by organ-preserving endoscopic resection or by gastrectomy with lymph-node dissection. This structured narrative, critical, and descriptive review examined clinical guidelines, prospective trials, comparative cohorts, systematic reviews, and meta-analyses identified in PubMed/MEDLINE, the Cochrane Library, and professional-society sources through August 2026. Endoscopic submucosal dissection provides excellent disease-specific survival when lesions satisfy validated criteria associated with a negligible risk of lymph-node metastasis and when histopathological assessment confirms curative resection. Comparative observational studies and meta-analyses generally show overall and disease-specific survival similar to gastrectomy in appropriately selected patients, with shorter hospitalization, fewer long-term treatment-related complications, better gastric-cancer-specific quality of life, and lower initial costs. Endoscopic treatment nevertheless produces more local, synchronous, and metachronous gastric neoplasms because the stomach remains at risk, resulting in lower recurrence-free survival and a lifelong requirement for endoscopic surveillance. Gastrectomy remains the reference treat ment when nodal risk is clinically relevant or endoscopic resection is noncurative. The choice should therefore be based on predicted lymph-node risk, probability of complete en bloc resection, physiological reserve, surveillance feasibility, and patient preferences rather than on chronological age or tumor depth alone.