Local or extragastric recurrence after incomplete endoscopic submucosal dissection of early gastric cancer: risk factors and the role of CT.
Abdom Radiol (NY). 2018 Dec;43(12):3250-3259. doi: 10.1007/s00261-018-1659-0.
Park SE1, Kim SH2,3, Kim SG4, Han JK1,5,6.
PURPOSE: To investigate the risk factors of local and extragastric recurrence after incomplete endoscopic submucosal dissection (ESD) of early gastric cancer and the role of CT in the surveillance of extragastric recurrence.
METHODS: Institutional review board approval was obtained for this retrospective study with waiver of informed consent. From January 2005 to April 2017, 2086 ESDs were performed. Among them, 202 patients who received incomplete ESDs with positive lateral or deep margins comprised our study population(M:F = 108:94, mean age = 63.3 years). Histopathology, size and depth of the tumor, margin status, and the presence of lymphovascular invasion(LVI) were recorded. The patients were followed-up for a mean period of 38.5 months (range 0.8-139 months). Univariate and multivariate statistical analyses were performed to assess the risk factors of local and extragastric recurrence.
RESULTS: 96 patients had (+) lateral margins, 90 had (+) deep margins and 16 had (+) lateral and deep margins. On subsequent surgery and follow-up, local gastric recurrence was found in 54 patients and extragastric recurrence was present in 13 patients. On multivariate analysis, (+) lateral margin [hazard radio (HR) 6.002; P < 0.0001] and tumor size(HR 1.372; P = 0.009) were demonstrated to be significant risk factors for local recurrence and (+) LVI was shown to be the only significant variable for extragastric recurrence(HR 6.798, P = 0.002).
CONCLUSION: A positive lateral margin and tumor size were significant risk factors for local recurrence while positive LVI was shown to be the only significant variable for extragastric recurrence. Therefore, if LVI is positive in patients who received incomplete ESD, subsequent surgery or follow-up with CT is recommended.