To compare the long-term efficacy of endoscopic submucosal dissection (ESD) and surgical resection for early remnant gastric cancer (ERGC) after R0 resection of gastric cancer.

The clinical and pathological data of patients with gastric cancer diagnosed as ERGC by endoscopic biopsy after R0 resection in our hospital from Jan. 2008 to Dec. 2016 were collected and divided into ESD group and surgical resection group according to the different treatment measures. All patients were followed up by telephone in May 2020. The en bloc resection rate, complete resection rate and curative resection rate of ESD group were calculated. The 5-year overall survival rate and the 5-year cause specific survival rate of ESD group and surgical resection group were calculated and compared.

A total of 32 patients with ERGC were included, including 21 patients in ESD group and 11 patients in surgical resection group. Among the 32 patients with ERGC, 31 (96.9%) were males. In ESD group, The en bloc resection rate was 76.2% (16/21), the complete resection rate was 71.4% (15/21), and the curative resection rate was 66.7% (14/21). There was no significant difference in 5-year overall survival rate between ESD group and surgical resection group (78.8% vs. 77.1%, P=0.764), but there was no significant difference in 5-year cause-specific survival rate (78.8% vs. 90.0%, P=0.538). Multivariate Cox regression analysis showed that invasion depth and lesion size were independent risk factors for prognosis of patients with ERGC.

The long-term efficacy of ESD is similar to that of surgical resection in patients with ERGC. ESD can be used as a safe and effective treatment option for ERGC, even the limited space of remnant stomach and severe submucosal fibrosis increase the difficulty of ESD.