Surgical Endoscopy

, Volume 24, Issue 11, pp 2842–2849 | Cite as

Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience

  • Jun Chul Park
  • Sang Kil LeeEmail author
  • Ju Hee Seo
  • Yu Jin Kim
  • Hyunsoo Chung
  • Sung Kwan Shin
  • Yong Chan Lee



Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection.


We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008.


Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again.


Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.


Early gastric cancer Endoscopic submucosal dissection Local recurrence 



The authors thank the members of Biostatistics and Dr. Beom Kyung Kim for statistical assistance.


Jun Chul Park, Sang Kil Lee, Ju Hee Seo, Yu Jin Kim, Hyunsoo Chung, Sung Kwan Shin, and Yong Chan Lee have no conflicts of interest or financial ties to disclose.


  1. 1.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1:10–24CrossRefPubMedGoogle Scholar
  2. 2.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMedGoogle Scholar
  3. 3.
    Okamura T, Tsujitani S, Korenaga D, Haraguchi M, Baba H, Hiramoto Y, Sugimachi K (1988) Lymphadenectomy for cure in patients with early gastric cancer and lymph node metastasis. Am J Surg 155:476–480CrossRefPubMedGoogle Scholar
  4. 4.
    Sue-Ling HM, Martin I, Griffith J, Ward DC, Quirke P, Dixon MF, Axon AT, McMahon MJ, Johnston D (1992) Early gastric cancer: 46 cases treated in one surgical department. Gut 33:1318–1322CrossRefPubMedGoogle Scholar
  5. 5.
    Noda M, Kodama T, Atsumi M, Nakajima M, Sawai N, Kashima K, Pignatelli M (1997) Possibilities and limitations of endoscopic resection for early gastric cancer. Endoscopy 29:361–365CrossRefPubMedGoogle Scholar
  6. 6.
    Watanabe K, Ogata S, Kawazoe S, Koyama T, Kajiwara T, Shimoda Y, Takase Y, Irie K, Mizuguchi M, Tsunada S, Iwakiri R, Fujimoto K (2006) Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 63:776–782CrossRefPubMedGoogle Scholar
  7. 7.
    Kojima T, Parra-Blanco A, Takahashi H, Fujita R (1998) Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 48:550–554 discussion 554PubMedGoogle Scholar
  8. 8.
    Ryu CB, Kim SG, Jung SW, Jung IS, Kwon KW JHS, Jin SY, Cho JY, Lee JS, Lee MS, Shim CS, Kim BS (2005) The usefulness and limitation of endoscopic mucosal resection using the incision and submucosa dissection methods (EISD) for early gastric cancer and gastric flat adenoma in Korea. Gastrointest Endosc 61:AB238CrossRefGoogle Scholar
  9. 9.
    Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883CrossRefPubMedGoogle Scholar
  10. 10.
    Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563CrossRefPubMedGoogle Scholar
  11. 11.
    Yokoi C, Gotoda T, Hamanaka H, Oda I (2006) Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 64:212–218CrossRefPubMedGoogle Scholar
  12. 12.
    Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, Sekine Y, Yano T, Satoh K, Ido K, Sugano K (2003) Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694CrossRefPubMedGoogle Scholar
  13. 13.
    Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5CrossRefPubMedGoogle Scholar
  14. 14.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225CrossRefPubMedGoogle Scholar
  15. 15.
    Suzuki Y, Hiraishi H, Kanke K, Watanabe H, Ueno N, Ishida M, Masuyama H, Terano A (1999) Treatment of gastric tumors by endoscopic mucosal resection with a ligating device. Gastrointest Endosc 49:192–199CrossRefPubMedGoogle Scholar
  16. 16.
    Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39:58–62CrossRefPubMedGoogle Scholar
  17. 17.
    Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226CrossRefPubMedGoogle Scholar
  18. 18.
    Hirao M, Masuda K, Asanuma T, Naka H, Noda K, Matsuura K, Yamaguchi O, Ueda N (1988) Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc 34:264–269CrossRefPubMedGoogle Scholar
  19. 19.
    Inoue H, Noguchi O, Saito N, Takeshita K, Endo M (1994) Endoscopic mucosectomy for early cancer using a pre-looped plastic cap. Gastrointest Endosc 40:263–264CrossRefPubMedGoogle Scholar
  20. 20.
    Miyamoto S, Muto M, Hamamoto Y, Boku N, Ohtsu A, Baba S, Yoshida M, Ohkuwa M, Hosokawa K, Tajiri H, Yoshida S (2002) A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 55:576–581CrossRefPubMedGoogle Scholar
  21. 21.
    Oda I, Gotoda T, Hamanaka H, Eguchi T, Saito Y, Matsuda T, Bhandari P, Emura F, Saito D, Ono H (2005) Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 17:54–56CrossRefGoogle Scholar
  22. 22.
    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 58:331–336CrossRefPubMedGoogle Scholar
  23. 23.
    Goto O, Fujishiro M, Kodashima S, Ono S, Omata M (2009) Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 41:118–122CrossRefPubMedGoogle Scholar
  24. 24.
    Jeong G, Lee JH, Yu MK, Moon W, Rhee PL, Paik SW, Rhee JC, Kim JJ (2006) Non-surgical management of microperforation induced by EMR of the stomach. Dig Liver Dis 38:605–608CrossRefPubMedGoogle Scholar
  25. 25.
    Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, Doi T, Otani Y, Fujisaki J, Ajioka Y, Hamada T, Inoue H, Gotoda T, Yoshida S (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270CrossRefPubMedGoogle Scholar
  26. 26.
    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 68:887–894CrossRefPubMedGoogle Scholar
  27. 27.
    Sagawa T, Takayama T, Oku T, Hayashi T, Ota H, Okamoto T, Muramatsu H, Katsuki S, Sato Y, Kato J, Niitsu Y (2003) Argon plasma coagulation for successful treatment of early gastric cancer with intramucosal invasion. Gut 52:334–339CrossRefPubMedGoogle Scholar
  28. 28.
    Kitamura T, Tanabe S, Koizumi W, Mitomi H, Saigenji K (2006) Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc 63:48–54CrossRefPubMedGoogle Scholar
  29. 29.
    Ogata M, Maejima K, Chihara N, Mizutani S, Komine O, Bo H, Shioya T, Watanabe M, Tokunaga A, Tajiri T (2007) Successful use of endoscopic argon plasma coagulation for patients with early gastric cancer and diabetes mellitus. J Nippon Med Sch 74:246–250CrossRefPubMedGoogle Scholar
  30. 30.
    Akhtar K, Byrne JP, Bancewicz J, Attwood SE (2000) Argon beam plasma coagulation in the management of cancers of the esophagus and stomach. Surg Endosc 14:1127–1130CrossRefPubMedGoogle Scholar
  31. 31.
    Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jun Chul Park
    • 1
  • Sang Kil Lee
    • 1
    • 2
    Email author
  • Ju Hee Seo
    • 1
  • Yu Jin Kim
    • 1
  • Hyunsoo Chung
    • 1
  • Sung Kwan Shin
    • 1
  • Yong Chan Lee
    • 1
  1. 1.Department of Internal Medicine, Institute of GastroenterologyYonsei University College of MedicineSeoulKorea
  2. 2.Division of Gastroenterology, Department of Internal MedicineYonsei University College of MedicineSeoulKorea

Personalised recommendations