Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection

Ryuta Takenaka, Yoshiro Kawahara, Hiroyuki Okada, Keisuke Hori, Masafumi Inoue, Seiji Kawano, Daisuke Tanioka, Takao Tsuzuki, Satoru Yagi, Jun Kato, Masayuki Uemura, Nobuya Ohara, Tadashi Yoshino, Atsushi Imagawa, Shigeatsu Fujiki, Rie Takata, Kazuhide Yamamoto

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Abstract

Background: Although endoscopic submucosal dissection (ESD) is expected to reduce the local recurrence of gastric cancers, we still experience cases of recurrence after an ESD. Objective: To characterize clinical and pathologic features of cases with local recurrence of early gastric cancer after an ESD. Design: A prospective cohort study. Setting and Patients: A total of 306 patients with gastric cancers removed by ESD at Okayama University Hospital and Tsuyama Central Hospital between March 2001 and December 2005 were enrolled. Intervention: ESD. Main Outcome Measurement: Local recurrence. Results: The incidence of a complete en bloc resection was 80.4% when pathologically evaluated. Within a median follow-up period of 26 months (12-64 months), a local recurrence was found in 7 cases, all of which had been declared incomplete resections. One patient underwent a second ESD, and the remaining 6 underwent a surgical resection. All removed lesions were mucosal cancers. No lymph-node metastases were found in patients with a surgical resection. There was a significant correlation between the incidence of an incomplete resection and that of a local recurrence (P < .0001). Among the clinical characteristics, tumor size (>30 mm vs <20 mm; odds ratio [OR] 16 mm [95% CI, 2.0-130 mm]) and tumor location (upper vs middle or lower; OR 7.6 [95% CI, 1.3-45]) were identified as factors that were significantly associated with the incidence of a local recurrence. Limitation: Short follow-up duration. Conclusions: The incidence of a local recurrence was strongly associated with that of an incomplete resection. The frequency of a local recurrence also showed significant correlations with the tumor size and location within the stomach.

Original languageEnglish
Pages (from-to)887-894
Number of pages8
JournalGastrointestinal Endoscopy
Volume68
Issue number5
DOIs
Publication statusPublished - Nov 1 2008

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Takenaka, R., Kawahara, Y., Okada, H., Hori, K., Inoue, M., Kawano, S., Tanioka, D., Tsuzuki, T., Yagi, S., Kato, J., Uemura, M., Ohara, N., Yoshino, T., Imagawa, A., Fujiki, S., Takata, R., & Yamamoto, K. (2008). Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointestinal Endoscopy, 68(5), 887-894. https://doi.org/10.1016/j.gie.2008.03.1089