title: Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection.
abstract: OBJECTIVE
  To clarify the safety and efficacy of repeat endoscopic submucosal dissection (re-ESD) for locally recurrent gastric cancers after ESD.
  
  
  METHODS
  A retrospective evaluation was performed of the therapeutic efficacy, complications and follow-up results from ESD treatment for early gastric cancers in 521 consecutive patients with 616 lesions at St. Luke`s International Hospital between April 2004 and November 2012. In addition, tumor size, the size of resected specimens and the operation time were compared between re-ESD and initial ESD procedures. A flex knife was used as the primary surgical device and a hook knife was used in cases with severe fibrosis in the submucosal layer. Continuous variables were analyzed using the non-parametric Mann-Whitney U test and are expressed as medians (range). Categorical variables were analyzed using a Fisher's exact test and are reported as proportions. Statistical significance was defined as a P-value less than 0.05.
  
  
  RESULTS
  The number of cases in the re-ESD group and the initial ESD group were 5 and 611, respectively. The median time interval from the initial ESD to re-ESD was 14 (range, 4-44 mo). En bloc resection with free lateral and vertical margins was successfully performed in all re-ESD cases without any complications. No local or distant recurrence was observed during the median follow-up period of 48 (range, 11-56 mo). Tumor size was not significantly different between the re-ESD group and the initial ESD group (median 22 mm vs 11 mm, P = 0.09), although the size of resected specimens was significantly larger in the re-ESD group (median 47 mm vs 34 mm, P < 0.05). There was a non-significant increase observed in re-ESD operation time compared to initial ESD (median 202 min vs 67 min, respectively, P = 0.06).
  
  
  CONCLUSIONS
  Despite the low patient number and short follow-up, the results suggest that re-ESD is a safe and effective endoscopic treatment for recurrent gastric cancer after ESD.
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Yuto
authors.initials: Y
authors.lastname: Shimamura
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nakano
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikeya
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Koyu
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Yuto Shimamura, Naoki Ishii, Kaoru Nakano, Takashi Ikeya, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujita
keywords: Endoscopic mucosal resection; Endoscopic submucosal dissection; Gastric cancer; Recurrent gastric cancer; Therapeutic endoscopy