Treatment of early gastric cancer in Sweden: A nationwide registry-based cohort study

Background and Aims: Endoscopic resection (ER) for early gastric cancer is a well-established treatment. Previous research is predominantly based on Asian patients. The aim of this study was to evaluate treatment strategies and outcomes for early gastric cancer in Sweden, based on data from a population-based cancer registry. Methods: We conducted a nationwide population-based cohort study using data from the Swedish National Registry for Esophageal and Gastric Cancer. All patients with pT1N0M0 gastric cancer or high-grade dysplasia who underwent surgical or ER between 2006 and 2022 were included. The primary endpoint was 5-year overall survival. Secondary endpoints included length of hospital stay, 30- and 90-day mortality rates, and postoperative complications. Results: In total, 278 patients were included. Of these, 189 (68.0%) underwent surgery and 89 (32.0%) ER. The two groups were comparable regarding baseline parameters (age, sex, smoking, ASA-score) but the surgery group had a higher clinical T-stage. The 5-year overall survival was 67 of 104 patients (64.4%) in the surgery group and 24 of 37 patients (64.9%) in the ER group. Multivariable Cox regression showed no difference between the groups ( p = 0.685). ER was associated with a shorter hospital stay (median 1 day compared to 9 days for surgery, p < 0.001). The 30- and 90-day mortality was 0 and 1 (1.1%) for ER and 4 (2.1%) and 9 (4.8%) for surgery ( p = 0.310 and 0.176, respectively). Complications occurred in 9 patients (12.7%) in the ER group and 42 (25.6%) in the surgery group. Conclusions: In this population-based study, ER and surgery had comparable 5-year overall survival for early gastric cancer. ER was associated with a shorter hospital stay and fewer postoperative complications.