Effect of endoscopic submucosal dissection on short-term surgical outcome after radical gastrectomy: a multicenter retrospective study based on the Korean Gastric Cancer Association nationwide survey.

PURPOSE: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis. However, 17%-21% of patients require additional curative gastrectomy (ACG) due to non-curative factors. Although ESD may induce fibrosis or adhesions that could complicate subsequent surgery, its impact on surgical outcomes after ACG remains unclear. This study aimed to evaluate the impact of prior ESD on postoperative outcomes following ACG. METHODS: We retrospectively analyzed national data from the Korean Gastric Cancer Association, including 11,594 patients with EGC who underwent gastrectomy between January 2019 and December 2019. Of these, 913 patients underwent ACG after non-curative ESD, while 10,681 underwent primary gastrectomy. Outcomes were compared between the ACG and surgery-only groups using 1:1 propensity score matching. RESULTS: A total of 1,826 matched patients were analyzed, with 913 patients in each group. There was no significant difference in severe complication rates (Clavien-Dindo grade ≥III) between the post-ESD group and the surgery-only group (4.4% vs. 5.3%, P = 0.986). Operative time, blood loss, and 30-day mortality were also comparable between groups. Higher body mass index (odds ratio [OR], 1.069; P = 0.043) and total gastrectomy (OR, 2.088; P = 0.006) were associated with an increased risk of severe complications. CONCLUSION: This study is the first to use national data to evaluate surgical outcomes after ACG following non-curative ESD. The results suggest that prior ESD does not adversely affect postoperative outcomes, providing evidence to guide surgical decision-making in patients with EGC requiring ACG.