Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3776
Peer-review started: June 11, 2018
First decision: July 6, 2018
Revised: July 31, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 7, 2018
To investigate the feasibility and safety of secondary endoscopic submucosal dissection (ESD) for residual or locally recurrent gastric tumors.
Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups.
The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD (78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group (10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD.
Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.
Core tip: Although secondary endoscopic submucosal dissection (ESD) is technically demanding, it can be applied to residual or recurrent tumors. We categorized secondary ESD into three groups according to the surgical strategy and analyzed them. There is no consensus on the timing of salvage ESD. This is the first study to report the feasibility and safety of secondary ESD according to the timing of ESD. Although secondary ESD requires greater technical efficiency and a longer procedure time, secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment.