Argon Plasma Coagulation Therapy for Early Gastric Cancer Is Effective and Operator Independent

Abstract

Backgrounds and Aims: Endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD) is one of important modalities for early gastric cancers. However, it requires high-leveled techniques and therefore is operator-dependent. On the other hand, argon plasma coagulation (APC) is considered as secondary treatment, such as for recurrence or post-endoscopic treatment, due to difficulties in evaluation of the cure. Accordingly, few reports are available that studies usefulness of APC therapy as a first-line treatment of early gastric cancer. However, APC has merits such as short-operation time, easy procedure, lack of serious complications and operator independent procedures, suggesting that this modality may be positively applied for some patients with early gastric cancers especially in the aged and/or those with complications. In this study, we investigated long-term outcome of early gastric cancers treated with APC and its efficacy as a first-line treatment. Methods: From 2003 to 2007, we performed APC to 50 lesions of gastric neoplasm (25 early gastric cancers and 25 gastric adenomas) in 38 patients (26 male, 12 female, mean 78 ± 8 years) in our hospital and a related hospital, in whom there was no indication of endoscopic therapy due to high risk of severe complications (such as cerebral infarction, paralysis, other malignant disease etc). We investigated the outcomes of such treatment (recurrence) by searching patients' records. In the APC procedure, the argon gas flow of 2 L/min at a power setting of 60-70W was used. In addition, to investigate how the operator skill affects the outcome, we studied the recurrence of the tumors in three patients' cohorts, which were defined according to the experience of the operator (0-3 years, 7-10 years, ≧15 years). Results: A total of 50 lesions were treated with a single APC procedure and followed up for 17-1897 days (median 663 days). Recurrence occurred in 5 lesions (10.0 %, 5/50), with an annual relapse rate of 5.06 %, and mean duration of recurrence was 554 days. Nevertheless re-treatment with APC (three cessions were maximally performed) was successful in all the relapsed lesions. There were no serious complications such as perforation, bleeding, or infection throughout all procedures. In addition, the outcomes were not different according to the experience of the operators. Conclusions: Annual relapse rate of gastric tumors was 5.1% when APC was applied as a first-line treatment. Combining with easy, safe and operator-independent features, this modality could be one of the therapeutic options for early gastric cancers in some patients especially with aged and/or those with complications.