Safety and efficacy of secondary endoscopic submucosal dissection for residual gastric carcinoma after primary endoscopic submucosal dissection.
OBJECTIVE
In endoscopic submucosal dissection (ESD), misdiagnosis of the tumor margin may lead to residual carcinoma, which we treat by secondary ESD (sESD) for local control.


METHODS
1,458 lesions of early gastric carcinoma were treated by ESD between July 2006 and November 2011. 33 lesions were resected with positive lateral margins. Among them, 13 patients were treated by surgery, 12 patients were followed up, and 8 patients were treated by sESD. sESD was defined as resection of residual carcinoma surrounding the ulcer of primary ESD (pESD). Safety and efficacy of sESD were retrospectively evaluated.


RESULTS
Mean interval between two ESDs was 8.4 days. The mean specimen area was 14.9 cm(2) in pESD and 23.9 cm(2) in sESD. The mean procedure time was 107.3 and 193.0 min, and mean dissection area was 15.9 and 11.6 mm(2)/min, respectively. There were no significant differences and no serious complications occurred during sESD. There was no local recurrence after a mean follow-up period of 896 days. Meanwhile, 4 cases of local recurrence were detected after ESD with a positive lateral margin.


CONCLUSIONS
The results suggest that sESD may be technically feasible and favorable for local control of residual gastric carcinoma.
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. dkiku1230@gmail.com
Daisuke
D
Kikuchi
Toshiro
T
Iizuka
Shu
S
Hoteya
Akihiro
A
Yamada
Tsukasa
T
Furuhata
Satoshi
S
Yamashita
Kaoru
K
Domon
Masanori
M
Nakamura
Akira
A
Matsui
Toshifumi
T
Mitani
Osamu
O
Ogawa
Sumio
S
Watanabe
Naohisa
N
Yahagi
Mitsuru
M
Kaise
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018365:Neoplasm, Residual; D061646:Operative Time; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors