Endoscopic submucosal dissection with adjuvant chemotherapy for early gastric cancer: Unnecessary complexity or added benefit? A real-world data analysis.

e16132 Background: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric cancer (EGC), offering high en bloc resection rates while preserving gastric function. However, the role of ESD alone in high-risk EGC patients remains controversial, as it may not address the potential for micrometastatic disease beyond the resected area. Adjuvant chemotherapy is frequently employed to reduce recurrence risk in such cases, but its benefits when combined with ESD are unclear. This study aims to evaluate whether adjuvant chemotherapy offers meaningful survival benefits or unnecessarily complicates treatment, particularly in real-world clinical settings where patient conditions vary. Methods: This retrospective study included 101 patients with early gastric cancer (T1a and T1b-SM1) treated at Zhongda Hospital Affiliated to Southeast University between January 2013 and December 2019. Patients were classified into three groups based on postoperative treatment: observation, surgery, and chemotherapy. All ESD procedures were performed by experienced gastroenterologists. Overall survival times were compared among the groups, and prognostic factors influencing patient outcomes were analyzed. Additionally, recurrence risk factors were examined, and a novel recurrence risk model was developed. Results: Patients in the surgery and chemotherapy groups exhibited significantly longer overall survival compared to those in the observation group. High-risk recurrence factors, such as histological grade, histological type, and Her2 expression, were more prevalent in the chemotherapy group. Moreover, the surgery group had significantly longer survival times compared to the chemotherapy group. The analysis suggested that decisions regarding additional surgery were primarily influenced by the physician's expertise and postoperative pathology, especially in patients with suspected lymph node metastasis. Conclusions: Surgical intervention and adjuvant chemotherapy significantly improve overall survival in patients with early gastric cancer (T1a and T1b-SM1) following ESD, particularly in those with high-risk recurrence factors.