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. 2016 Apr 10;8(7):330-7.
doi: 10.4253/wjge.v8.i7.330.

Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer

Ju Yup Lee  1 , Kwang Bum Cho  1 , Eun Soo Kim  1 , Kyung Sik Park  1 , Yoo Jin Lee  1 , Yoon Suk Lee  1 , Byoung Kuk Jang  1 , Woo Jin Chung  1 , Jae Seok Hwang  1
Affiliations

Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer

Ju Yup Lee et al. World J Gastrointest Endosc. .

Abstract

Aim: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC).

Methods: A total of 1121 patients (1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients (415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions.

Results: Local recurrence after en bloc ESD was found in 36 cases (8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach (OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm (log-rank test, P = 0.03).

Conclusion: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in cases in which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.

Keywords: Early gastric cancer; En bloc resection; Endoscopic mucosal resection; Endoscopic submucosal dissection; Recurrence.

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Figures

Figure 1
Figure 1
Flow chart of the patients. EGC: Early gastric cancer.
Figure 2
Figure 2
Cumulative neoplasia recurrence free rate according to period after endoscopic submucosal dissection. The probability of no recurrence up to 24 mo was 79.9% in those with the safety resection margin ≤ 1 mm and 89.5% in those exceeded 1 mm.
See this image and copyright information in PMC

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