Long-Term Results of Endoscopic Resection in Early Gastric Cancer: The Western Experience

Abstract

Background: In the West, long-term results of endoscopic resection (ER) for early gastric cancer (EGC) have not yet been reported. The aim of this study was to prospectively evaluate efficacy and safety of ER in patients (pt) with EGC in a long-term follow-up. Methods: From 05/95 to 10/04, 179 pt were referred to our department for endoscopic therapy of gastric cancer (GC). Of those, 43 pt had intramucosal GC with a diameter of up to 30 mm and underwent ER with a curative intent. All pt underwent a strict follow-up (FU) protocol in regular intervals. Results: 42 of the 43 pt fulfilled our low-risk criteria for endoscopic therapy (ET) of EGC (gross tumor type I/II, intramucosal GC, diameter up to 30 mm, tumor differentiation G1/G2, no infiltration into lymph vessels/veins). 2 pt were lost for FU (remission status not evaluated). In another pt, gastric MALT-lymphoma was detected simultaneously, and he was referred to surgery. 38 (97%) of the remaining 39 pt that underwent definitive ET (23 male (59%); mean age 69 ± 10 years) achieved CR after a mean of 1.3 ± 0.6 ER sessions. Minor complications (not Hb-relevant bleeding) occured in 7/39 pt (18%); major ones (5 Hb-relevant bleedings; 1 covered perforation; all managed conservatively) in 6 pt (15%). During a mean FU of 57 months (range 5-137), recurrent or metachronous lesions were observed in 11 pt (29%). All lesions were successfully treated by repeated ET. No tumor-related death occurred during FU. Conclusions: ER for EGC is effective also in “Western hands” but is associated with a relevant risk of complications. In view of the possibility of recurrent or metachronous neoplasia, a strict follow-up protocol is mandatory.