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

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer.
• Locally recurrent gastric cancer after ESD presents a treatment challenge.
• Repeat ESD (re-ESD) is being explored as a potential therapeutic option.

Purpose of the Study:

• To evaluate the safety and efficacy of repeat endoscopic submucosal dissection (re-ESD) for locally recurrent gastric cancers following initial ESD.
• To compare outcomes between re-ESD and initial ESD procedures.

Main Methods:

• Retrospective analysis of 521 patients with 616 early gastric cancer lesions treated with ESD.
• Comparison of tumor size, resected specimen size, and operation time between re-ESD and initial ESD groups.
• Statistical analysis using Mann-Whitney U test and Fisher's exact test.

Main Results:

• Five patients underwent re-ESD, with a median interval of 14 months after initial ESD.
• All re-ESD cases achieved en bloc resection with clear margins and no complications.
• No local or distant recurrence was observed during a median follow-up of 48 months.
• Resected specimen size was significantly larger in re-ESD cases (median 47 mm vs 34 mm).
• Operation time for re-ESD was longer but not statistically significant (median 202 min vs 67 min).

Conclusions:

• Repeat endoscopic submucosal dissection (re-ESD) appears to be a safe and effective endoscopic treatment for gastric cancer recurrence after initial ESD.
• Despite a small sample size and limited follow-up, re-ESD demonstrates promising results for managing recurrent disease.