Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection

AIM: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 followup 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 11mm,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 nonsignificant increase observed in re-ESD operation time compared to initial ESD(median 202 min vs 67 min,respectively,P=0.06).CONCLUSION: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.