Endoscopic submucosal dissection: a safe alternative to surgical intervention for young patients under 45 years of age with early gastric cancer. ESD vs. surgery in young EGC patients.

[BACKGROUND] Endoscopic submucosal dissection (ESD) is considered a standard therapy for individuals diagnosed with early gastric cancer (EGC) who demonstrate minimal risk of lymph node metastasis. This study aims to compare the efficacy and safety of ESD for EGC versus surgery for EGC in young patients ≤ 45 years old, assess ESD outcomes and effectiveness across different age groups, and evaluate post-treatment quality of life (QoL) in young patients undergoing ESD or surgery.

[MATERIALS AND METHODS] This multicenter study retrospectively analyzed data from January 2015 to December 2022, comparing ESD and surgery outcomes, post-treatment QoL in young patients (≤ 45 years), and assessing ESD efficacy across age groups (≤ 45, 46-65, > 65 years).

[RESULTS] Among 154 young patients, 41 underwent ESD, and 113 had surgery, with ESD showing comparable overall survival (OS) 97.6% and disease-free survival (DFS) 97.6% to surgery (OS: 99.1%, DFS: 99.1%) without significant differences (p > 0.05). Across 833 patients who underwent ESD for EGC, ESD demonstrated high efficacy in all age groups, with consistent DFS rates (p = 0.575) and high OS rates (97.6% for ≤ 45, 99.3% for 46-65, 97.6% for > 65). Regarding post-treatment QoL, ESD resulted in fewer complications, such as nausea (p = 0.001) and diarrhea (p = 0.043), than surgery. ESD patients also maintained stable weight and BMI, unlike surgery patients who experienced reductions.

[CONCLUSION] ESD is a safe and effective treatment for EGC in young patients, providing comparable survival outcomes to surgery and offering better post-treatment QoL, which is especially beneficial for young patients due to its effectiveness and favorable impact on QoL.