Endoscopic submucosal dissection (ESD) offers better long-term survival than gastrectomy for older patients with early gastric cancer.

• 5-year overall survival was 85.9% with ESD vs. 80.9% for gastrectomy (p=0.140).
• In patients aged 80+, gastrectomy had a 3.29 times higher risk of death and a 7.18 times higher risk of gastric cancer-specific death than ESD.

Consider ESD for patients aged 80+ and those with mucosa-confined lesions to improve outcomes.

• In mucosa-confined lesions, gastrectomy saw a 6.11 times increased risk of cancer-specific mortality.