Close observation after noncurative endoscopic resection for early gastric cancer is an acceptable option if a positive horizontal margin or piecemeal resection of differentiated-type adenocarcinoma is the only noncurative factor.
When locally recurrent early gastric cancer is subsequently detected, endoscopic submucosal dissection may be performed, although only limited research has been reported regarding the outcomes.
Dr Masau Sekiguchi and colleagues from Japan evaluated the effectiveness, safety, and long-term clinical outcomes of endoscopic submucosal dissection performed for locally recurrent early gastric cancer.
|En bloc resection was achieved in 91%|
Endoscopic resection was performed in 3704 patients with a total of 4216 early gastric cancer lesions between 1997 and 2011.
During this period, 95 patients with 95 locally recurrent early gastric cancers following their endoscopic resection underwent endoscopic submucosal dissection performed by experts.
The prior endoscopic resection procedures were endoscopic mucosal resection in 75 cases, and endoscopic submucosal dissection in 20.
The doctors reported that of 95 cases, en bloc resection was achieved in 91%, R0 resection in 84%, and curative resection in 81%.
Median procedure time was 70 minutes.
The research team observed no bleeding that required blood transfusion.
There were 6 perforations, with 1 necessitating emergency surgery.
Within a median follow-up period of 76 months, second local recurrences occurred in three patients.
The research team found that the 5-year overall, and disease-specific survival rates were 93% and 100%, respectively.
Dr Sekiguchi's team concludes, "Endoscopic submucosal dissection was safe and effective with favorable long-term clinical outcomes for locally recurrent early gastric cancer following endoscopic resection."