Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection

Shu Hoteya, Toshiro Iizuka, Daisuke Kikuchi, Toshifumi Mitani, Akira Matsui, Osamu Ogawa, Tsukasa Furuhata, Satoshi Yamashta, Akihiro Yamada, Mitsuru Kaise, Naohisa Yahagi

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19 Citations (Scopus)


Background: Endoscopic submucosal dissection (ESD) is a widely accepted technique for the management of gastric tumors. However, residual or recurrent tumors can occur after ESD; currently, there is no adequate management strategy for these tumors. Thus, the aim of the present study was to establish a strategy of secondary ESD (sESD) for cases with positive lateral margins (LM+), which cause post-ESD residual or recurrent tumors.

Methods: Fifty-three lesions that were subjected to ESD were diagnosed as LM+ with suspected local residual tumor. The short- and long-term outcomes of early sESD (performed shortly after the initial ESD in LM+ cases to prevent local recurrence) were retrospectively compared with those of late sESD (performed after the detection of recurrent tumors).

Results: Of the 53 LM+ cases, the local residual positive rate was 38.5 % (10/26) in those undergoing early sESD or additional surgery and the local recurrence rate was 29.6 % (8/27) in those that were not treated. Thus, the overall incidence of residual or recurrent tumors in LM+ cases was 34.0 % (18/53). Both early and late sESD had favorable outcomes with no severe complications: 100 % of early sESD resections were curative, compared with 86.7 % of late sESD resections, over the course of a mean (±SD) observation period of 50.8 ± 16.7 months. The performance of early sESD was significantly greater than that of late sESD (in terms of dissection speed).

Conclusions: Early sESD is more reliable than late sESD as a therapeutic strategy for salvaging residual tumors and for preventing recurrence. However, if a tumor has already recurred, late sESD remains useful.

Original languageEnglish
Pages (from-to)697-702
Number of pages6
JournalGastric Cancer
Issue number4
Publication statusPublished - 2014 Sept 20


  • ESD
  • Gastric tumor
  • Long-term outcomes
  • Residual or recurrent tumors
  • Secondary ESD

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research


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