Routine follow-up biopsies after complete endoscopic resection for early gastric cancer may be unnecessary

Abstract

Purpose: Local recurrence, due to residual tumor, may occur after endoscopic resection for early gastric cancer. The aims of this study are to evaluate the predictive factors for local recurrence, and suggest an appropriate follow-up biopsy strategy.

Materials and methods: We retrospectively reviewed 396 early gastric cancers from 372 consecutive patients, who underwent endoscopic resection between January 2002 and April 2008. Cumulative recurrence rates were determined by the Kaplan-Meier method, and Cox proportional hazard analysis was used to determine the risk factors for local recurrence.

Results: Local recurrence at the endoscopic resection site was found in 17 cases, among the total 396 lesions, during a median follow-up period of 48 months. The 5-year cumulative local recurrence rate was 4.8%. Multivariate analyses determined that tumor involvement at the lateral resection margin [hazard ratio: 35.9; P<0.001], uncheckable lateral resection margin [hazard ratio: 16.8; P<0.001], uncheckable or involved deep resection margin [hazard ratio: 3.76; P=0.047], and piecemeal resection [hazard ratio: 3.95; P=0.007] were associated with local recurrence. If a lesion was positive for any of these risk factors, the 5-year cumulative recurrence rate was 27.0%, while local recurrence was not found in any lesion that lacked these risk factors. Most episodes of recurrence were found during the first or second follow-up endoscopic biopsy at the ulcer scar.

Conclusions: Routine follow-up biopsies at the endoscopic resection site might be unnecessary in cases where an early gastric cancer lesion was endoscopically resected en bloc with tumor-free lateral and deep margins.

Keywords: Biopsy; Endoscopic resection; Gastric cancer; Recurrence; Risk factors.

Fig. 1

Flow chart. EGC = early gastric cancer; ER = endoscopic resection; NCC = National Cancer Center; APC = argon plasma coagulation.

Fig. 2

Overall cumulative recurrence rate of the follow-up group after endoscopic resection for early gastric cancer.

Fig. 3

Kaplan-Meier plots in follow-up patients (n=396). Local recurrence rates according to the following risk factors. (A) Lateral resection margin status, (B) deep resection margin status, (C) piecemeal resection, (D) one or more risk factors. Log-rank test was used to evaluate the significance. LM (-) = free lateral resection margin; LM (+) = involved or uncheckable lateral resection margin; DM (-) = free deep resection margin; DM (+) = involved or uncheckable deep resection margin.