Outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection: analysis of a multicenter prospective cohort study.

[BACKGROUND] We aimed to reveal the outcomes of endoscopic resection (ER) for locally recurrent early gastric cancer (LRGC) after ER using the data obtained in a Japanese multicenter prospective cohort study of ER for early gastric cancer (EGC) using Web registry (J-WEB/EGC).

[METHODS] Short-term and long-term outcomes were compared between 125 LRGCs (119 patients) and 9387 primary EGCs of naive stomach (8455 patients) enrolled in this study at 41 centers between July 2010 and June 2012. We calculated 5-year overall survival rates (OS) and disease-specific survival rates (DSS) for LRGC, divided ERs into curative and noncurative resections, and calculated hazard ratios (HR) for all-cause mortality with Cox regression analysis.

[RESULTS] For LRGCs and primary EGCs, median resection times were 100 and 77 min (p<0.0001), en-bloc resection rates were 97.6% and 99.5% (p<0.05), and R0 resection rates were 86.4% and 93.3% (p<0.05), respectively. There were no significant differences for adverse events between LRGC and primary EGC. Five-year OS and DSS for LRGC cases were 89.9% and 100%. Compared to curatively resected primary EGC cases, HR for all-cause mortality of curatively resected LRGC, noncuratively resected primary EGC and noncuratively resected LRGC cases were 0.58 (95% CI 0.24-1.41), 1.46 (1.25-1.7) and 3.02 (1.43-6.36), respectively.

[CONCLUSIONS] A curative ER for LRGC offers the same long-term prognosis as primary EGC. ER for LRGC can offer a secure and radical treatment.