Routine follow-up biopsies after complete endoscopic resection for early gastric cancer may be unnecessary.
OBJECTIVE
Local recurrence, due to residual tumor, may occur after endoscopic resection for early gastric cancer. The aims of this study are to evaluate the predictive factors for local recurrence, and suggest an appropriate follow-up biopsy strategy.


METHODS
We retrospectively reviewed 396 early gastric cancers from 372 consecutive patients, who underwent endoscopic resection between January 2002 and April 2008. Cumulative recurrence rates were determined by the Kaplan-Meier method, and Cox proportional hazard analysis was used to determine the risk factors for local recurrence.


RESULTS
Local recurrence at the endoscopic resection site was found in 17 cases, among the total 396 lesions, during a median follow-up period of 48 months. The 5-year cumulative local recurrence rate was 4.8%. Multivariate analyses determined that tumor involvement at the lateral resection margin [hazard ratio: 35.9; P<0.001], uncheckable lateral resection margin [hazard ratio: 16.8; P<0.001], uncheckable or involved deep resection margin [hazard ratio: 3.76; P=0.047], and piecemeal resection [hazard ratio: 3.95; P=0.007] were associated with local recurrence. If a lesion was positive for any of these risk factors, the 5-year cumulative recurrence rate was 27.0%, while local recurrence was not found in any lesion that lacked these risk factors. Most episodes of recurrence were found during the first or second follow-up endoscopic biopsy at the ulcer scar.


CONCLUSIONS
Routine follow-up biopsies at the endoscopic resection site might be unnecessary in cases where an early gastric cancer lesion was endoscopically resected en bloc with tumor-free lateral and deep margins.
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Jong Yeul
JY
Lee
Il Ju
IJ
Choi
Soo-Jeong
SJ
Cho
Chan Gyoo
CG
Kim
Myeong-Cherl
MC
Kook
Jun Ho
JH
Lee
Keun Won
KW
Ryu
Young-Woo
YW
Kim