Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy

Abstract

As the long-term outcome of surgical treatment for gastric cancer improves, the chance of detecting early residual gastric cancer (RGC) during postoperative follow-up is increasing. 1,2 Reports have shown that duodenogastric reflux and Helicobacter pylori infection are important factors in the development of RGC. 3 In previous studies, RGCs after distal gastrectomy accounted for 1%-8% of all gastric cancers. 4,5 Thus, the demand for RGC treatment is increasing.Endoscopic submucosal dissection (ESD) is considered minimally invasive and curative in treating superficial gastrointestinal cancers, including esophageal, gastric, and colonic cancers. 6 ESD provides high rates of en bloc and complete resection, regardless of the size or shape of the tumor. Owing to the preservation of function and lower invasiveness of ESD compared to surgical resection, ESD seems desirable for RGCs after distal gastrectomy. However, performing ESD for RGCs is technically challenging due to the limited working space in