Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 10, 2016; 8(7): 330-337
Published online Apr 10, 2016. doi: 10.4253/wjge.v8.i7.330
Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer
Ju Yup Lee, Kwang Bum Cho, Eun Soo Kim, Kyung Sik Park, Yoo Jin Lee, Yoon Suk Lee, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang
Ju Yup Lee, Kwang Bum Cho, Eun Soo Kim, Kyung Sik Park, Yoo Jin Lee, Yoon Suk Lee, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 41931, South Korea
Author contributions: Lee JY reviewed the literature and drafted the manuscript; Cho KB designed and supervised research; Kim ES and Park KS designed and advised research; Lee YJ and Lee YS performed data collection and statistical analysis; Jang BK, Chung WJ and Hwang JS reviewed manuscript and advised.
Institutional review board statement: This study was approved by the Institutional Review Board of the Keimyung University Dongsan Medical Center, South Korea (DSMC 2015-10-047).
Informed consent statement: The institutional review board waived the requirement for informed consent because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment.
Conflict-of-interest statement: The authors have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kwang Bum Cho, MD, PhD, Department of Internal Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, South Korea. chokb@dsmc.or.kr
Telephone: +82-53-2507088 Fax: +82-53-2507442
Received: November 9, 2015
Peer-review started: November 10, 2015
First decision: December 18, 2015
Revised: January 1, 2016
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: April 10, 2016
Processing time: 147 Days and 15.8 Hours
Abstract

AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC).

METHODS: A total of 1121 patients (1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients (415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions.

RESULTS: Local recurrence after en bloc ESD was found in 36 cases (8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach (OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm (log-rank test, P = 0.03).

CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in cases in which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.

Keywords: Early gastric cancer; Endoscopic mucosal resection; Recurrence; En bloc resection; Endoscopic submucosal dissection

Core tip: Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence following en bloc endoscopic submucosal dissection (ESD) for early gastric cancer. Lesions located in the upper third of the stomach demonstrated more recurrences than those located in the lower third of the stomach. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in cases in which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.