title: Pattern of extragastric recurrence and the role of abdominal computed tomography in surveillance after endoscopic resection of early gastric cancer: Korean experiences.
abstract: BACKGROUND
  Although extragastric recurrence after endoscopic resection of early gastric cancer is rare, it is important because of its potentially fatal outcomes. We investigated the patterns of extragastric recurrence after endoscopic resection and evaluated the role of abdominal computed tomography in surveillance.
  
  
  METHODS
  Between July 1994 and June 2014, 4915 patients underwent endoscopic resection of early gastric cancer. Because of follow-up periods of less than 6 months and consecutive surgery within 1 year, 810 patients were excluded. Thus, 4105 patients were retrospectively reviewed.
  
  
  RESULTS
  The median follow-up period was 37 months (interquartile range 20-59.6 months). The overall incidence of extragastric recurrence was 0.37% (n = 15). In patients who underwent curative resection, the incidence was 0.14% (n = 5). There were three recurrences in the absolute indication group, six in the expanded indication group, and six in the beyond expanded indication group. The median time to extragastric recurrence was 17 months (interquartile range 16.5-43.2 months). Of the 15 extragastric recurrences, 11 were in the regional lymph nodes and 4 were in the liver, adrenal gland, and peritoneum. Sixty percent (9/15) of the extragastric recurrences occurred without intragastric lesions. Eleven recurrences were detected by abdominal computed tomography, and eight patients underwent curative surgery.
  
  
  CONCLUSIONS
  After endoscopic resection of early gastric cancer, regional lymph node recurrence is the predominant extragastric recurrence pattern, which can be detected via abdominal computed tomography and cured by rescue surgery. Abdominal computed tomography should be considered as a surveillance method, especially in patients with an expanded indication.
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Sunpyo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea. keedonchoi@gmail.com.
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung-Mo
authors.initials: SM
authors.lastname: Hong
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Gong
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Hee Kyong
authors.initials: HK
authors.lastname: Na
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D056910:Republic of Korea; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Abdominal CT; Early gastric cancer; Endoscopic resection; Extragastric recurrence; Surveillance