Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection

Background and study aim: Close observation after noncurative endoscopic resection for early gastric cancer (EGC) is an acceptable option if a positive horizontal margin or piecemeal resection of differentiated-type adenocarcinoma is the only noncurative factor. When locally recurrent EGC is subsequently detected, endoscopic submucosal dissection (ESD) may be performed, although only limited research has been reported regarding the outcomes. We aimed to evaluate the effectiveness, safety, and long-term clinical outcomes of ESD performed for locally recurrent EGC.

Patients and methods: Endoscopic resection was performed in 3704 patients with a total of 4216 EGC lesions between January 1997 and December 2011 at our institution. During this period, 95 patients with 95 locally recurrent EGCs following their endoscopic resection underwent ESD performed by experts, which we retrospectively reviewed. The prior endoscopic resection procedures were endoscopic mucosal resection in 75 cases and ESD in 20.

Results: Of the 95 cases, en bloc resection was achieved in 90.5 %, R0 resection in 84.2 %, and curative resection in 81.1 %. Median procedure time was 70 minutes; no bleeding requiring blood transfusion was seen. There were six perforations (6.3 %), with one necessitating emergency surgery. Within a median follow-up period of 76.4 months (range, 10.5 – 170.0 months), second local recurrences occurred in three patients. Five-year overall and disease-specific survival rates were 92.8 % and 100 %, respectively.

Conclusions: ESD was safe and effective with favorable long-term clinical outcomes for locally recurrent EGC following endoscopic resection.

• References

• 1 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
• 2 Oda I, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 2005; 17: 54-58
• 3 Oda I, Saito D, Tada M et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
• 4 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
• 5 Gotoda T, Iwasaki M, Kusano C et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 2010; 97: 868-871
• 6 Goto O, Fujishiro M, Kodashima S et al. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009; 41: 118-122
• 7 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113-123
• 8 Korenaga D, Orita H, Maekawa S et al. Pathological appearance of the stomach after endoscopic mucosal resection for early gastric cancer. Br J Surg 1997; 84: 1563-1566
• 9 Nagano H, Ohyama S, Fukunaga T et al. Indications for gastrectomy after incomplete EMR for early gastric cancer. Gastric Cancer 2005; 8: 149-154
• 10 Oda I, Gotoda T, Sasako M et al. Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg 2008; 95: 1495-1500
• 11 Oka S, Tanaka S, Kaneko I et al. Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection. Endoscopy 2006; 38: 996-1000
• 12 Yokoi C, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 2006; 64: 212-218
• 13 Fujishiro M, Goto O, Kakushima N et al. Endoscopic submucosal dissection of stomach neoplasms after unsuccessful endoscopic resection. Dig Liver Dis 2007; 39: 566-571
• 14 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
• 15 Bae SY, Jang TH, Min BH et al. Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cancer. Gastrointest Endosc 2012; 75: 432-436
• 16 Kikuchi D, Iizuka T, Hoteya S et al. Safety and efficacy of secondary endoscopic submucosal dissection for residual gastric carcinoma after primary endoscopic submucosal dissection. Digestion 2012; 86: 288-293
• 17 Itoh H, Oohata Y, Nakamura K et al. Complete ten-year postgastrectomy follow-up of early gastric cancer. Am J Surg 1989; 158: 14-16
• 18 Sano T, Sasako M, Kinoshita T et al. Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature. Cancer 1993; 72: 3174-3178
• 19 Maruyama K, Kaminishi M, Hayashi K et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 2006; 9: 51-66
• 20 Roviello F, Rossi S, Marrelli D et al. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol 2006; 94: 275-280
• 21 Gotoda T, Friedland S, Hamanaka H et al. A learning curve for advanced endoscopic resection. Gstrointest Endosc 2005; 62: 866-867
• 22 Kakushima N, Fujishiro M, Kodashima S et al. A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy 2006; 38: 991-995
• 23 Oda I, Odagaki T, Suzuki H et al. Learning curve for endoscopic submucosal dissection of early gastric cancer based on trainee experience. Dig Endosc 2012; 24: 129-132
• 24 Yamamoto Y, Fujisaki J, Ishiyama A et al. Current status of training for endoscopic submucosal dissection for gastric epithelial neoplasm at Cancer Institute Hospital, Japanese Foundation for Cancer Research, a famous Japanese hospital. Dig Endosc 2012; 24: 148-153