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Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group
  1. Motohiko Kato1,
  2. Tsutomu Nishida1,
  3. Katsumi Yamamoto2,
  4. Shiro Hayashi2,
  5. Shinji Kitamura3,
  6. Takamasa Yabuta3,
  7. Toshiyuki Yoshio4,
  8. Takeshi Nakamura5,
  9. Masato Komori6,
  10. Naoki Kawai7,
  11. Akihiro Nishihara8,
  12. Fumihiko Nakanishi9,
  13. Masanori Nakahara10,
  14. Hideharu Ogiyama11,
  15. Kazuo Kinoshita12,
  16. Takuya Yamada1,
  17. Hideki Iijima1,
  18. Masahiko Tsujii1,
  19. Tetsuo Takehara1
  1. 1Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  2. 2Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
  3. 3Department of Gastroenterology, Sakai City Hospital, Sakai, Osaka, Japan
  4. 4Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan
  5. 5Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
  6. 6Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  7. 7Department of Gastroenterology, Osaka Police Hospital, Osaka, Osaka, Japan
  8. 8Department of Gastroenterology, Minoh City Hospital, Minoh, Osaka, Japan
  9. 9Department of Gastroenterology, Osaka Minami Medical Centre, National Hospital Organization, Kawachi-Nagano, Osaka, Japan
  10. 10Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Osaka, Japan
  11. 11Department of Gastroenterology, Itami City Hospital, Itami, Japan
  12. 12Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan
  1. Correspondence to Tetsuo Takehara, Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan; takehara{at}


Background After endoscopic submucosal dissection (ESD) of early gastric cancer (EGC), patients are at high risk for synchronous or metachronous multiple gastric cancers.

Objective To elucidate the time at which multiple cancers develop and to determine whether scheduled endoscopic surveillance might control their development.

Design A multicentre retrospective cohort study from 12 hospitals was conducted. Patients with EGC who underwent ESD with en bloc margin-negative curative resection were included. Synchronous cancer was classified as concomitant cancer or missed cancer. The cumulative incidence of metachronous cancers and overall survival rate were calculated using the Kaplan–Meier method.

Results From April 1999 to December 2010, 1258 patients met the inclusion criteria. Synchronous or metachronous multiple cancers were detected in 175 patients (13.9%) during a mean of 26.8 months. Among the 110 synchronous cancers, 21 were missed at the time of the initial ESD. Many of the missed lesions existed in the upper third of the stomach and the miss rate was associated with the endoscopist's inexperience (<500 oesophagogastroduodenoscopy cases). The cumulative incidence of metachronous cancers increased linearly and the mean annual incidence rate was 3.5%. The incidence rate did not differ between patients with or without Helicobacter pylori eradication. Four lesions (0.32%) were detected as massively invading cancers during the follow-up.

Conclusions Nineteen per cent of synchronous cancers were not detected until the initial ESD. The incidence rate of metachronous cancer after ESD was constant. Scheduled endoscopic surveillance showed that almost all recurrent lesions were treatable by endoscopic resection.

  • Gastric Cancer
  • Gastric Carcinoma

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