Rescue Therapy for Recurrent Gastric Cancer after Endoscopic Resection

Kim, Ji Hyun

Abstract

Popularity of endoscopic screening and advances in high-resolution endoscopic images have led to the detection of early-staged gastric cancer more often than before in Korea. As endoscopic submucosal dissection (ESD) according to the expanded criteria is widely accepted by many Korean endoscopists, the increase in incomplete resection and local recurrence after endoscopic resection are inevitable. Locoreginal recurrences after successful endoscopic resection including regional lymph node metastasis (LNM) and direct invasion to adjacent organs, and distant hematogenous metastasis are very rare because the risk of LNM is minimal in early gastric cancer, especially those indicated for endoscopic therapy. However, local recurrence by residual cancer and metachronous or synchronous recurrence are of clinical importance. Additional endoscopic resection can be considered when pathologic examination of endoscopic mucosal resection (EMR) or ESD reveal differentiated mucosal cancer. Endoscopic ablation therapy such as argon plasma coagulation can reduce the procedure time and is valuable in technically difficult cases and when the risk of post-procedural luminal stricture is high. Radical surgery is mandatory in cases with submucosal invasion or in cases with suspicious large amount of residual cancer. With regard to the synchronous or metachronous recurrent cancers, treatment strategy is the same as primary gastric cancers. The risk of luminal stricture should be considered when choosing the treatment method, especially when the lesion is located at the distal antrum, pyloric channel and esophagogastric junction.