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