title: Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study.
abstract: BACKGROUND
  The aim of the present study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) based on the long-term outcomes.
  
  
  METHODS
  From June 2002 to March 2007, ESD was carried out in 472 cases and 570 lesions of EGC. Post-surgical cases and status-unknown cases were excluded. The following long-term outcomes were examined in 438 patients who were reliably followed up for at least 5 years after treatment (range: 5 years [60 months] to 9 years, 9 months [117 months]): local recurrence, metachronous recurrences, and the survival rate.
  
  
  RESULTS
  The overall en bloc resection rate was 97.7% for all lesions treated by ESD. The median procedure time was 47.0 min (range 8-345 min). The incidence of positive horizontal andvertical margins was 3.7% and 3.4%, respectively. The incidence of perforation and postoperative bleeding was 5.3% and 4.3%, respectively. There were no deaths related to ESD. Local recurrence was observed in five patients (1.1%), and metachronous recurrences in 7.8% of the patients. The post-treatment 5-year survival was 83.1%. There were no deaths as a result of gastric cancer associated with sites treated by ESD.
  
  
  CONCLUSIONS
  ESD can be considered a standard treatment for EGC based on its expanded indications and low incidences of local recurrence and lymph node metastasis.
authors.affiliation: Department of Gastroenterology and Hepatology, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Masaki
authors.initials: M
authors.lastname: Endo
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Toya
authors.forename: Yukito
authors.initials: Y
authors.lastname: Abiko
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kudara
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inomata
authors.forename: Toshimi
authors.initials: T
authors.lastname: Chiba
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takikawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Suzuki
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sugai
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: endoscopic submucosal dissection (ESD); gastric cancer; long-term outcome