Gastrectomy Is Superior to Endoscopic Resection for Gastric Cancer in Several Metrics

Woo H-T, Kang SH, Baek JY, et al. Long-Term Survivorship after Gastrectomy or Endoscopic Resection for Gastric Cancer Using Nationwide Real-World Data. J Am Coll of Surg. 2025; in press. 

Gastrectomy can be used to cause weight loss, thereby reducing incidence of metabolic syndrome, major adverse cardiovascular events (MACE), and other diseases. However, less is known about these outcomes when a gastrectomy is used to treat gastric cancer.

Researchers from Seoul National University in Seongnam, Korea, used Korean National Health Insurance data of patients with gastric cancer who were treated with gastrectomy (49,578 patients) or endoscopic resection (ER; 24,789 patients). Via data from 2002 to 2020, they compared 15-year survivorship, MACE, and chronic disease incidence.

For patients with overweight or normal body weight, undergoing gastrectomy rather than ER lowered the risk of developing new-onset hypertension (hazard ratio [HR], 0.53), heart failure (HR, 0.77), ischemic heart disease (HR, 0.80), and cerebrovascular disease (HR, 0.78). For underweight patients, only the risk of heart failure was reduced (HR, 0.61). For those in the overweight group, the risk of developing diabetes also declined (HR, 0.86). Analyses found the risk of MACE in the gastrectomy group was reduced by 24% relative to the ER group.

Those who underwent gastrectomy rather than ER were also less likely to develop cancers (HR, 0.82–0.90) and had lower risk of cancer mortality (HR, 0.74–0.86). However, they also had higher risk of mortality via respiratory diseases (HE, 1.62), trauma and suicide (HR, 1.38), and other causes.

The authors noted their results align with those of other studies and that a forthcoming trial will further examine onco-metabolic operation outcomes in gastric cancer patients.