Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a multicenter collaborative study.
OBJECTIVE
The indications for endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC) have been expanded. However, the long-term outcomes of ESD remain unclear. We retrospectively investigated the long-term outcomes of ESD in patients with EGC.


METHODS
We retrospectively studied patients with EGC who underwent ESD at 11 institutions between January 2003 and December 2010. A total of 6456 patients (7979 lesions) who met the absolute indications for ESD and 4202 patients (5781 lesions) who met the expanded indications for ESD were studied. Clinicopathological features, clinical course, and outcomes were studied in 67 patients in whom local recurrence or metastatic recurrence was diagnosed as of March 31, 2014. The median follow-up period was 56 months.


RESULTS
Local recurrence was diagnosed in 14 patients (0.22%) who met the absolute indications and 53 patients (1.26%) who met the expanded indications. The rate of local recurrence was significantly higher in patients with expanded-indication lesions (p < 0.05). As additional treatment for recurrence, most patients received endoscopic treatment. Metastatic recurrence did not develop in any patient with absolute-indication lesions, but was diagnosed in 6 patients (0.14%) with expanded-indication lesions (p < 0.05). The histological type was undifferentiated mixed type in half the patients. Three patients died of primary gastric cancer.


CONCLUSIONS
ESD for expanded-indication lesions of EGC is considered an effective therapy associated with an extremely low rate of metastatic recurrence on long-term follow-up. However, fully informed consent concerning the risk of metastatic recurrence should be obtained before ESD, and close postoperative follow-up is essential.
Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan. s-tanabe@kitasato-u.ac.jp.
Satoshi
S
Tanabe
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
Kenji
K
Ishido
Department of Gastroenterology, Iwate Medical University, Morioka, Japan.
Takayuki
T
Matsumoto
Department of Gastroenterology, Iwate Medical University, Morioka, Japan.
Takashi
T
Kosaka
Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Ichiro
I
Oda
Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Haruhisa
H
Suzuki
Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan.
Junko
J
Fujisaki
Department of Endoscopy, Shizuoka Prefectural Cancer Center, Nagaizumi, Japan.
Hiroyuki
H
Ono
Department of Endoscopy, Shizuoka Prefectural Cancer Center, Nagaizumi, Japan.
Noboru
N
Kawata
Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
Tsuneo
T
Oyama
Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
Akiko
A
Takahashi
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Hisashi
H
Doyama
Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
Masaaki
M
Kobayashi
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Noriya
N
Uedo
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Kenta
K
Hamada
Division of Gastroenterology, Kobe University Graduate School of Medicine, Kusunoki, Japan.
Takashi
T
Toyonaga
Division of Gastroenterology, Kobe University Graduate School of Medicine, Kusunoki, Japan.
Fumiaki
F
Kawara
Department of Endoscopic Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Shinji
S
Tanaka
Department of Endoscopic Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Yoshikazu
Y
Yoshifuku
D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
Absolute-indication lesions; ESD; Early gastric cancer; Expanded-indication lesions; Outcomes