Role of computed tomography scan for the primary surveillance of mucosal gastric cancer after complete resection by endoscopic submucosal dissection

Background: Abdominal computed tomography (CT) scan is periodically performed in almost all patients with early gastric cancer after undergoing endoscopic submucosal dissection (ESD). However, little is known about the diagnostic yield of CT scans for tumors that recurred after curative resection by ESD. Methods: A total of 1,175 mucosal gastric cancers treated by ESD between January 2007 and December 2012 were retrospectively reviewed. Of them, 894 initial-onset early gastric cancers with two or more endoscopies with biopsy and one or more CT scans were included for survival analysis. Results: The median follow-up period was 19.7 months (interquartile range, 11.3-35.4 months), during which time 81 lesions recurred. Of these, 35 recurred as an adenoma, whereas the others recurred as cancer. Of the 81 lesions that recurred, 79 were not diagnosed by abdominal CT scan but rather by endoscopy with biopsy. The remaining two lesions, which recurred as metachronous cancers, had suspicious CT scan findings, such as focal gastric wall thickening. The lesions also were confirmed by endoscopic biopsy, which was performed on the same day. None of the lesions was diagnosed by CT scan before pathologic confirmation by endoscopic biopsy. Conclusions: Computed tomography scan has a minor role for the surveillance of mucosal gastric cancer after complete resection by ESD. Endoscopy with biopsy should be the primary surveillance option after ESD.