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Comparison Between Redo Endoscopic Treatment and Surgery in Patients with Locally Recurrent Gastric Neoplasms

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Treatment of locally recurrent gastric neoplasms after endoscopic resection remains challenging. We investigated the efficacy and safety of treatment options for recurrent gastric neoplasms localized to the scar of previous endoscopic submucosal dissection (ESD).

Methods

The clinicopathological characteristics and treatment outcomes of patients who underwent endoscopic treatment or surgery for recurrent gastric neoplasms between June 2010 and May 2017 were retrospectively reviewed.

Results

Of the 92 patients included, 74 underwent endoscopic treatment (51 redo ESD, 23 argon plasma coagulation [APC] ablation) and 18 underwent surgery. The redo ESD procedure time was significantly longer than that of the primary ESD (31.0 versus 22.0 min, p = 0.018). Overall, adverse events occurred in 11 patients (12.0%), with the incidence being significantly higher in the surgery group (27.8% versus 8.1% in the endoscopic treatment group, p = 0.036). Local recurrence-free survival rates were 81.1% for the endoscopic treatment group (86.3% and 69.6% for redo ESD and APC groups, respectively) and 100% for the surgery group (log rank p = 0.033). Logistic regression analysis showed that tumor size > 12.5 mm (odds ratio [OR] 5.14, 95% confidence interval [CI] 1.25–26.9, p = 0.032) and tumors located in the upper two-thirds of the stomach (OR 4.43, 95% CI 1.27–16.8, p = 0.023) were associated with non-curative resection after redo ESD.

Conclusions

Endoscopic treatment could be an effective and safe alternative to surgery for selected patients with gastric neoplasms recurring at the scar of previous ESD. Especially, patients having small lesions located in the distal part of the stomach could be a good candidate for redo ESD.

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Young Kwon Choi, Do Hoon Kim, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Jeong Hoon Lee, Kee Don Choi, Ho June Song & Hwoon-Yong Jung

  2. Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, South Korea

    Eun Jeong Gong

  3. Department of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jeong Hwan Yook & Byung Sik Kim

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  1. Young Kwon Choi
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  2. Do Hoon Kim
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  3. Eun Jeong Gong
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Corresponding author

Correspondence to Do Hoon Kim.

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The study was approved by the institutional review board of the Asan Medical Center (registration number 2017-0641).

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The authors declare that they have no conflict of interest.

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Electronic Supplementary Material

Supplementary Figure 1

Receiver operator characteristics curve for non-curative resection after redo endoscopic submucosal dissection according to the size of the tumor. (PNG 66 kb)

High resolution image (EPS 7 kb)

Supplementary Table 1

(DOCX 16 kb)

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Choi, Y.K., Kim, D.H., Gong, E.J. et al. Comparison Between Redo Endoscopic Treatment and Surgery in Patients with Locally Recurrent Gastric Neoplasms. J Gastrointest Surg 24, 1489–1498 (2020). https://doi.org/10.1007/s11605-019-04303-z

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  • DOI: https://doi.org/10.1007/s11605-019-04303-z

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