Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection.


BACKGROUND Although endoscopic submucosal dissection (ESD) is expected to reduce the local recurrence of gastric cancers, we still experience cases of recurrence after an ESD. OBJECTIVE To characterize clinical and pathologic features of cases with local recurrence of early gastric cancer after an ESD. DESIGN A prospective cohort study. SETTING AND PATIENTS A total of 306 patients with gastric cancers removed by ESD at Okayama University Hospital and Tsuyama Central Hospital between March 2001 and December 2005 were enrolled. INTERVENTION ESD. MAIN OUTCOME MEASUREMENT Local recurrence. RESULTS The incidence of a complete en bloc resection was 80.4% when pathologically evaluated. Within a median follow-up period of 26 months (12-64 months), a local recurrence was found in 7 cases, all of which had been declared incomplete resections. One patient underwent a second ESD, and the remaining 6 underwent a surgical resection. All removed lesions were mucosal cancers. No lymph-node metastases were found in patients with a surgical resection. There was a significant correlation between the incidence of an incomplete resection and that of a local recurrence (P < .0001). Among the clinical characteristics, tumor size (>30 mm vs <20 mm; odds ratio [OR] 16 mm [95% CI, 2.0-130 mm]) and tumor location (upper vs middle or lower; OR 7.6 [95% CI, 1.3-45]) were identified as factors that were significantly associated with the incidence of a local recurrence. LIMITATION Short follow-up duration. CONCLUSIONS The incidence of a local recurrence was strongly associated with that of an incomplete resection. The frequency of a local recurrence also showed significant correlations with the tumor size and location within the stomach.

DOI: 10.1016/j.gie.2008.03.1089
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@article{Takenaka2008RiskFA, title={Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection.}, author={Ryuta Takenaka and Yoshiro Kawahara and Hiroyuki Okada and Keisuke Hori and M. Inoue and Seiji Kawano and Daisuke Tanioka and Takao Tsuzuki and Satoru Yagi and Jun Kato and Masayuki Uemura and Nobuya Ohara and Tadashi Yoshino and Atsushi Imagawa and Shigeatsu Fujiki and Rie Takata and Kazuhide Yamamoto}, journal={Gastrointestinal endoscopy}, year={2008}, volume={68 5}, pages={887-94} }