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
Endoscopic submucosal dissection (ESD) is an accepted curative treatment option for gastric tumors with very low local recurrence. However, residual or locally recurrent tumors occur rarely after ESD. Although secondary ESD is technically demanding, it can be applied to residual or recurrent tumors with scar and dense fibrotic submucosa. We investigated the feasibility and safety of secondary ESD for gastric tumors. We also categorized secondary ESD into three groups according to the surgical strategy (early salvage, late salvage, or late secondary ESD) and analyzed them.
There is no consensus on the timing of salvage ESD. Until now, there were few reports about the feasibility and effectiveness of early salvage ESD.
To investigate the feasibility and safety of secondary 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%. The average procedure time of secondary ESD was significantly longer than primary ESD, and the adverse events rate was not statistically different but trended slightly higher in the secondary ESD group compared to the primary ESD group. 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.
Although it requires greater technical efficiency and longer procedure time, secondary ESD of residual or locally recurrent gastric tumors appears to be feasible and curative treatment.
Secondary ESD of residual or locally recurrent gastric tumors is a feasible and curative treatment.