title: Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection.
abstract: OBJECTIVE
  The aim of this study was to elucidate the risk factors for local recurrence after endoscopic mucosal resection (EMR) treatment for superficial esophageal cancer (SEC).
  
  
  METHODS
  We performed a retrospective analysis of the clinical course of 62 patients with 64 SECs that were treated by EMR between 1993 and 2004. Follow-up examinations by chromoscopy with iodine solution and biopsy were performed 3 months, 6 months, 12 months, and then annually after EMR. Local recurrence was defined as a histologically confirmed finding of cancer cells at the site of the preceding EMR. The contributions of lesion-related and procedure-related factors to local recurrence were analyzed retrospectively.
  
  
  RESULTS
  Local recurrence was detected in 14/64 SECs 3-36 months after EMR. Of the lesion-related factors we assessed, local recurrence was found to be more frequent in SECs with a larger diameter (P = 0.01), larger circumferential spread (P = 0.04), or deeper invasion (P = 0.04), although the last two factors failed to demonstrate statistical significance after correction for multiple testing. Piecemeal resection did not increase the risk of local recurrence (P = 0.11), but the need for adjunctive coagulation therapy was found to increase the risk of local recurrence (P = 0.06).
  
  
  CONCLUSIONS
  Larger SECs are associated with a higher risk of local recurrence after EMR. In patients with residual lesions, coagulation therapy does not seem to be adequate as additional endoscopic treatment.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mesaki@intmed2.med.kyushu-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Esaki
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Hirakawa
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.forename: J
authors.initials: J
authors.lastname: Umeno
authors.forename: H
authors.initials: H
authors.lastname: Koga
authors.forename: T
authors.initials: T
authors.lastname: Yao
authors.forename: M
authors.initials: M
authors.lastname: Iida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012307:Risk Factors