Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection.

Abstract

For residual gastric tumors (RT) found at the treated sites after endoscopic resections (ER), additional treatment options are additional ER, surgery or argon plasma coagulation (APC). Long-term efficacy of APC as the curative modality for RT has not been fully elucidated. This study aimed to investigate the efficacy and long-term outcome of APC for RT with relevant tumor factors. Eighty-two patients who received ER for gastric adenocarcinoma or adenoma and were subsequently treated with APC for RT were reviewed retrospectively. Characteristics of the tumors curatively ablated with single-session of APC and the non-curatively ablated were compared by multiple logistic regression analysis. Overall rate of curative ablation and follow-up duration was calculated. Initial tumor size <20mm [odds ratio for second residual recurrence (OR) 0.16; 95% confidence interval (CI) 0.039-0.63], en-bloc resection (OR 0.16; 95% CI 0.039-0.72), histologic complete resection (OR 0.14; 95% CI 0.028-0.66) and RT with flat or depressed type (OR 0.20; 95% CI 0.051-0.77) were significantly associated with curative ablation of RT by single-session of APC. Anterior wall or lesser curvature location showed a tendency toward curative APC, but not reached statistical significance (OR 0.36; 95% CI 0.11-1.16). A total of 60 patients (73.2%) achieved curative ablation after single-session of APC. Eleven among the patients (n=22) with second or more residual recurrence achieved curative ablation with one or two more additional sessions of APC. Overall rate of curative ablation was 86.6% (71/82). From the last APC, the final curative ablation group (n=71) has been followed up for 49.7±37.4months. En-bloc resection, histologic complete resection, RT with flat or depressed type and initial tumor size less than 2cm can be predictors of favorable clinical outcome of APC as an additional treatment for RT. For selected patients with RT, APC and close monitoring could be a reasonable alternative to immediate resection.