Local Recurrence in Early Gastric Cancer with Curative Resection achieved through Endoscopic Submucosal Dissection

Aims We investigated the local recurrence rate and its risk factors among patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and were judged to have undergone curative resection.

Methods We enrolled patients who were diagnosed with EGC and underwent ESD between 2006 and 2020. Local recurrence after ESD was confirmed by histopathological evaluation by endoscopic biopsy at the ESD site during endoscopic surveillance.

Results A total of 936 patients underwent ESD for EGC, achieved curative resection, and were followed up for more than 12 months. Among them, 14 cases of local recurrence were found (14/936, 1.5%) during 53.2 months of follow-up. Compared with patients without local recurrence, those with local recurrence showed male predominance (677/922 vs. 14/14, P=0.025), frequent presence of synchronous tumor (123/922 vs. 6/14, P=0.001) and larger tumor size (16.3 vs. 26.3 mm, P=0.001). Kaplan-Meier graph also showed that local recurrence significantly occurred in the subgroup with male, presence of synchronous tumor, and tumor size≥20 mm (P=0.028, 0.009 and<0.001 by log rank test, respectively). After propensity score matching for gender, age, and comorbidities with 1:5 ratio, tumor size≥20 mm was the only significant factor for local recurrence (odds ratio: 3.886, 95% confidence interval: 1.012-14.922, P=0.048)

Conclusions Endoscopists should be cautious about local recurrence at the ESD site even after curative resection of EGC, especially for large tumor sizes.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024