Abstract
Background
Abdominal computed tomography (CT) scan is periodically performed in almost all patients with early gastric cancer after undergoing endoscopic submucosal dissection (ESD). However, little is known about the diagnostic yield of CT scans for tumors that recurred after curative resection by ESD.
Methods
A total of 1,175 mucosal gastric cancers treated by ESD between January 2007 and December 2012 were retrospectively reviewed. Of them, 894 initial-onset early gastric cancers with two or more endoscopies with biopsy and one or more CT scans were included for survival analysis.
Results
The median follow-up period was 19.7 months (interquartile range, 11.3–35.4 months), during which time 81 lesions recurred. Of these, 35 recurred as an adenoma, whereas the others recurred as cancer. Of the 81 lesions that recurred, 79 were not diagnosed by abdominal CT scan but rather by endoscopy with biopsy. The remaining two lesions, which recurred as metachronous cancers, had suspicious CT scan findings, such as focal gastric wall thickening. The lesions also were confirmed by endoscopic biopsy, which was performed on the same day. None of the lesions was diagnosed by CT scan before pathologic confirmation by endoscopic biopsy.
Conclusions
Computed tomography scan has a minor role for the surveillance of mucosal gastric cancer after complete resection by ESD. Endoscopy with biopsy should be the primary surveillance option after ESD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123
Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942
Lee H, Yun WK, Min BH, Lee JH, Rhee PL, Kim KM, Rhee JC, Kim JJ (2011) A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 25:1985–1993
Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, Choi KS, Kim do H, Song HJ, Lee GH, Kim JH, Park YS (2011) Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 74:485–493
Yamaguchi N, Isomoto H, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Ohnita K, Hayashi T, Nakao K, Kohno S, Shikuwa S (2009) Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria. Digestion 80:173–181
Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336
Park CH, Shin S, Park JC, Shin SK, Lee SK, Lee YC, Lee H (2013) Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication. Dig Liver Dis 45(8):651–656
Choi MK, Kim GH, Park DY, Song GA, Kim DU, Ryu DY, Lee BE, Cheong JH, Cho M (2013) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc 27(11):4250–4258
Polkowski M, Palucki J, Wronska E, Szawlowski A, Nasierowska Guttmejer A, Butruk E (2004) Endosonography versus helical computed tomography for locoregional staging of gastric cancer. Endoscopy 36:617–623
Lee IJ, Kim SH, Lee JM, Kim SK, Kim MA, Han JK, Choi BI (2009) Multidetector row computed tomographic gastrography findings after endoscopic submucosal dissection for early gastric cancer: emphasis on time evolution and factors for predicting residual tumor. J Comput Assist Tomogr 33:273–279
Sohn YJ, Jang JS, Choi SR, Kwon HC, Jung GJ, Kim MC, Jeong JS (2009) Early detection of recurrence after endoscopic treatment for early gastric cancer. Scand J Gastroenterol 44:1109–1114
Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112
Nakajima T, Oda I, Gotoda T, Hamanaka H, Eguchi T, Yokoi C, Saito D (2006) Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance? Gastric Cancer 9:93–98
Takeda J, Toyonaga A, Koufuji K, Kodama I, Aoyagi K, Yano S, Ohta J, Shirozu K (1998) Early gastric cancer in the remnant stomach. Hepatogastroenterology 45:1907–1911
Hosokawa O, Kaizaki Y, Watanabe K, Hattori M, Douden K, Hayashi H, Maeda S (2002) Endoscopic surveillance for gastric remnant cancer after early cancer surgery. Endoscopy 34:469–473
Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S, Tanioka D, Tsuzuki T, Yagi S, Kato J, Uemura M, Ohara N, Yoshino T, Imagawa A, Fujiki S, Takata R, Yamamoto K (2008) Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 68:887–894
Disclosures
Chan Hyuk Park, Eun Hye Kim, Jun Chul Park, Sung Kwan Shin, Yong Chan Lee, Sang Kil Lee, and Hyuk Lee have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Park, C.H., Kim, E.H., Chung, H. et al. Role of computed tomography scan for the primary surveillance of mucosal gastric cancer after complete resection by endoscopic submucosal dissection. Surg Endosc 28, 1307–1313 (2014). https://doi.org/10.1007/s00464-013-3327-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3327-3