Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection

M. Esaki; T. Matsumoto; K. Hirakawa; S. Nakamura; J. Umeno; H. Koga; T. Yao; M. Iida

doi:10.1055/s-2006-945143

Endoscopy, Table of Contents

Endoscopy 2007; 39(1): 41-45
DOI: 10.1055/s-2006-945143

Original article

Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection

M. Esaki¹ , T. Matsumoto¹ , K. Hirakawa¹ , S. Nakamura¹ , J. Umeno¹ , H. Koga² , T. Yao³ , M. Iida¹

¹Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
²Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
³Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Abstract

Background and study aim: The aim of this study was to elucidate the risk factors for local recurrence after endoscopic mucosal resection (EMR) treatment for superficial esophageal cancer (SEC). Patients and methods: We performed a retrospective analysis of the clinical course of 62 patients with 64 SECs that were treated by EMR between 1993 and 2004. Follow-up examinations by chromoscopy with iodine solution and biopsy were performed 3 months, 6 months, 12 months, and then annually after EMR. Local recurrence was defined as a histologically confirmed finding of cancer cells at the site of the preceding EMR. The contributions of lesion-related and procedure-related factors to local recurrence were analyzed retrospectively. Results: Local recurrence was detected in 14/64 SECs 3 - 36 months after EMR. Of the lesion-related factors we assessed, local recurrence was found to be more frequent in SECs with a larger diameter (P =0.01), larger circumferential spread (P = 0.04), or deeper invasion (P = 0.04), although the last two factors failed to demonstrate statistical significance after correction for multiple testing. Piecemeal resection did not increase the risk of local recurrence (P = 0.11), but the need for adjunctive coagulation therapy was found to increase the risk of local recurrence (P = 0.06). Conclusions: Larger SECs are associated with a higher risk of local recurrence after EMR. In patients with residual lesions, coagulation therapy does not seem to be adequate as additional endoscopic treatment.

Full Text

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M. Esaki, MD

Department of Medicine and Clinical Science
Graduate School of Medical Sciences
Kyushu University

Maidashi 3-1-1
Higashi-ku
Fukuoka 812-8582
Japan

Fax: +81-92-642-5273

Email: mesaki@intmed2.med.kyushu-u.ac.jp