To analyze the short-term and long-term outcomes of patients with early gastric cancer treated by endoscopic submucosal dissection (ESD) and the characteristics of early cardiac gastric cancer.

The clinicopathological and follow-up data of 98 patients with early gastric cancer who underwent ESD at the Endoscopy Center of Peking University People's Hospital from August 2012 to July 2021 were analyzed retrospectively. The clinical features of patients and endoscopic futures of lesions, en bloc resection and complete resection rates, complications after procedure, residual and recurrence rate, and incidence of synchronous and metachronous cancer were analyzed. Kaplan-Meier method was used to analyze the survival of patients in the curative group and non-curative group. The differences between cardiac and non-cardiac lesions were also analyzed.

A total of 98 patients (105 lesions) were included in the study. The lesions were located in the cardia in 20 cases (20.4%, 20/98). The en bloc resection rate was 98.1%, and the complete resection rate was 90.5%. No positive vertical margin was found, and vessels were positive in 1.9% of the lesions. According to the eCura system, 88.6% of the lesions were in the curative resection group and 11.4% in the non-curative resection group. Postoperative bleeding occurred in 2.9% of the cases, and no postoperative perforation occurred. Multivariate analysis showed that lesions larger than 2 cm and pathological undifferentiation type were independent risk factors for incomplete resection. The incidence of residual and local recurrence was 2.1%, and the rates of synchronous and metachronous cancer were 2.1% and 5.3%, respectively. The overall 5-year survival rate was 98.8%, the 5-year disease-specific survival rate was 100%, and the 5-year disease-free survival rate was 88.4%. There was no significant difference between the curative resection group and the non-curative resection group (86.2% vs 81.8%, P=0.310) for 5-year disease free survival rate. Compared with the non-cardiac group, the cardiac group had a higher residual and recurrence rate (10.5% vs 0%, P＜0.05). The 5-year disease-free survival rate of the cardiac group was lower than that of the non-cardiac group, but the difference was not statistically significant (77.5% vs 88.3%, P=0.071).

ESD has good efficacy and safety for early gastric cancer lesions meeting the surgical indications. The long-term prognosis is excellent, even for patients with non-curative resection after appropriate postoperative treatment. Patients with early cardiac gastric cancer may have different characteristics and prognosis compared with those with early non-cardiac gastric cancer.