384 Background: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for EGC but it is still difficult to avoid postoperative recurrence. Gastric adenocarcinoma recurrence post-ESD presents significant management challenges. Methods: A retrospective review was conducted on 163 adenocarcinoma cases treated with ESD at Seoul Paik Hospital, Seoul, South Korea. This study aims to analyze the characteristics, recurrence patterns, and outcomes of adenocarcinoma cases following ESD in a single center. Results: The mean age of patients was 70.7 years, with a male predominance (79.1%). Hypertension (49.1%), diabetes mellitus (25.2%), and dyslipidemia (14.7%) were common comorbidities. Most carcinomas were located in the antrum (52.1%) and body (33.7%). In the pathological findings, Lauren classification showed 84.7% intestinal type, 2.5% diffuse type, and 12.9% mixed type. Most tumors were staged as pT1a (80.4%), with an R0 resection rate of 74.2%. Recurrence was observed in 11% of cases, with synchronous (4.9%) and metachronous (6.1%) patterns. Synchronous recurrences were detected on average at 140.3 days, with half treated by additional ESD and half by operative gastrectomy. Metachronous recurrences, detected on average at 1056.5 days, were primarily managed with operative gastrectomy (70%). Conclusions: This study underscores the complexity of gastric adenocarcinoma management post-ESD, highlighting the importance of vigilant monitoring recurrences. The diversity in recurrence patterns and pathology necessitates personalized treatment and follow-up strategies, emphasizing the role of tailored post-ESD care in optimizing patient outcomes.
Moon et al. (2026) studied this question.