Predictive factors for local recurrence after endoscopic resection for early gastric cancer: Long-term clinical outcome in a single-center experience

Jun Chul Park, Sang Kil Lee, Ju Hee Seo, Yu Jin Kim, Hyunsoo Chung, Sung Kwan Shin, Yong Chan Lee

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Abstract

Background: Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection. Methods: We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008. Results: Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again. Conclusions: Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.

Original languageEnglish
Pages (from-to)2842-2849
Number of pages8
JournalSurgical endoscopy
Volume24
Issue number11
DOIs
Publication statusPublished - 2010 Nov

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Stomach Neoplasms
Recurrence
Argon Plasma Coagulation
Endoscopic Mucosal Resection
Lymph Nodes
Prospective Studies
Neoplasm Metastasis
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{4c1b345139c9446e9eecbbfb31e8d65a,
title = "Predictive factors for local recurrence after endoscopic resection for early gastric cancer: Long-term clinical outcome in a single-center experience",
abstract = "Background: Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection. Methods: We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008. Results: Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64{\%} (32/50) and 60{\%} (30/50), respectively, in the EMR group, and 86.8{\%} (164/189) and 79.9{\%} (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18{\%} vs. 3.7{\%}, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again. Conclusions: Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.",
author = "Park, {Jun Chul} and Lee, {Sang Kil} and Seo, {Ju Hee} and Kim, {Yu Jin} and Hyunsoo Chung and Shin, {Sung Kwan} and Lee, {Yong Chan}",
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Predictive factors for local recurrence after endoscopic resection for early gastric cancer : Long-term clinical outcome in a single-center experience. / Park, Jun Chul; Lee, Sang Kil; Seo, Ju Hee; Kim, Yu Jin; Chung, Hyunsoo; Shin, Sung Kwan; Lee, Yong Chan.

In: Surgical endoscopy, Vol. 24, No. 11, 11.2010, p. 2842-2849.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictive factors for local recurrence after endoscopic resection for early gastric cancer

T2 - Long-term clinical outcome in a single-center experience

AU - Park, Jun Chul

AU - Lee, Sang Kil

AU - Seo, Ju Hee

AU - Kim, Yu Jin

AU - Chung, Hyunsoo

AU - Shin, Sung Kwan

AU - Lee, Yong Chan

PY - 2010/11

Y1 - 2010/11

N2 - Background: Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection. Methods: We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008. Results: Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again. Conclusions: Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.

AB - Background: Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection. Methods: We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008. Results: Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again. Conclusions: Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.

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