title: Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection.
abstract: BACKGROUND
  A new technique, endoscopic submucosal dissection (ESD), which uses specially developed endoscopic knives, was recently developed for en bloc resection of large lesions. Despite increasing indications for endoscopic resection (ER), there are limited data available regarding the outcome of ER for lesions 20 mm or more in diameter.
  
  
  OBJECTIVE
  To investigate the risk factors for local recurrence.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A cancer-referral center.
  
  
  METHODS
  Seventy patients, who presented between September 1994 and April 2006, with a total of 78 lesions that measured 20 mm or more in diameter.
  
  
  METHODS
  Local recurrence rate after ER was assessed.
  
  
  RESULTS
  At a median follow-up of 32 months (range 12-121 months), there were 12 local recurrences (15.4%). There was no significant association between local recurrence and multiple iodine-voiding lesions, tumor size, or tumor location. The number of resections and the resection method, however, were significantly associated with local recurrence. There was no recurrence of lesions treated by en bloc resection. Lesions resected in 5 or more pieces had a significantly higher recurrence rate than lesions resected in 2 to 4 pieces. Lesions treated by EMR had a significantly higher recurrence rate than lesions treated by ESD.
  
  
  CONCLUSIONS
  Single-center retrospective analysis.
  
  
  CONCLUSIONS
  Esophageal squamous-cell carcinoma that measured 20 mm or more in diameter should be resected en bloc by ESD. Lesions treated by resection in 5 or more pieces have a higher risk for local recurrence.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Motohiko
authors.initials: M
authors.lastname: Kato
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Eriko
authors.initials: E
authors.lastname: Masuda
authors.forename: Koichi
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tatsuta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors