Background and study aims: As more early gastric cancer (EGC) patients are being treated with endoscopic submucosal
dissection (ESD), it is important to understand the outcomes of patients who develop
metachronous gastric cancer (MGC). The aim of this study was to evaluate the long-term
surveillance and treatment outcomes of MGC after curative gastric ESD.
Patients and methods: The study included 1526 consecutive patients who underwent curative ESD resection
of EGC. They were generally followed by annual or biannual esophagogastroduodenoscopy.
The risk factors and treatment outcomes for MGC were assessed along with the 5-year,
7-year, and 10-year cumulative incidence functions of MGC and disease-specific survival
(DSS).
Results: During a median follow-up period of 82.2 months, 238 patients developed MGC post-ESD
resection of EGC. The 5-year, 7-year, and 10-year cumulative incidence functions of
MGC were 9.5 %, 13.1 % and 22.7 %, respectively. Male sex and multiple initial EGCs
were independent risk factors for MGC in the Cox proportional hazard model. Of the
238 patients with MGC, 215 were treated with endoscopic resection, of which 183 achieved
curative resection, although one patient later died of his initial EGC. A further
14 patients were treated surgically, three had metastatic disease and received palliative
chemotherapy, and the remaining six were observed without any intervention. A total
of seven patients died of MGC, five at least 5 years after their index ESD. The 5-year,
7-year, and 10-year DSSs were 99.2 %, 98.6 %, and 92.5 %, respectively.
Conclusions: The incidence of MGC increases with time after curative gastric ESD, therefore surveillance
endoscopy should be continued indefinitely.
