Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy

Takenaka, Ryuta; Kawahara, Yoshiro; Okada, Hiroyuki; Tsuzuki, Takao; Yagi, Shunjiro; Kato, Jun; Ohara, Nobuya; Yoshino, Tadashi; Imagawa, Atsushi; Fujiki, Shigeatsu; Takata, Rie; Nakagawa, Masahiro; Mizuno, Motowo; Inaba, Tomoki; Toyokawa, Tatsuya; Sakaguchi, Kohsaku

doi:10.1016/j.gie.2007.10.021

Cited by 43 publications

(40 citation statements)

References 13 publications

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“…SG should also be selected for a patient whose tumor can be resected with a sufficient margin. For RGC that surrounds an anastomotic site, the preoperative diagnosis for invasion depth and endoscopic treatment is difficult because of massive fibrosis around the suture line [11]. A remnant gastric cancer with the preoperative diagnosis of muscularis propia in depth might be deeper in the pathological diagnosis of the resected specimen.…”

Section: Discussionmentioning

confidence: 99%

“…At present, detection of early remnant gastric cancer (ERGC) is increasing as a result of the development of endoscopic technology and a surveillance program with periodic endoscopy [8][9][10]. Endoscopic mucosal resection and submucosal dissection are applicable for treatment of ERGC; however, endoscopic treatment in the remnant stomach is technically difficult because of the narrow inner space and presence of massive fibrosis around the suture line [11].…”

Section: Introductionmentioning

confidence: 99%

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Limited subtotal gastrectomy for early remnant gastric cancer

et al. 2013

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Background Detection of early remnant gastric cancer (ERGC) is increasing as a result of the development of endoscopic technology and a surveillance program. The aim of this study was to evaluate the results of limited subtotal gastrectomy (SG) surgery for ERGC compared to total gastrectomy (TG). Methods We retrospectively reviewed a database of 72 consecutive patients with remnant gastric cancer who underwent laparotomy at the National Cancer Center Hospital East between January 1993 and December 2008. Thirty-five patients with a preoperative diagnosis of ERGC underwent curative resection: 13 SG and 22 conventional TG. Patients and tumor characteristics, operative results, and postoperative assessments 1 year after surgery were compared between the two groups. Results Operating time, blood transfusion, and hospital stay were similar in the two groups. In the SG group, blood loss and postoperative recovery of body weight tended to be better than in the TG group. There was no dumping syndrome in the SG group, while this occurred in three patients in the TG group. The levels of hemoglobin and total protein were higher 1 year after remnant gastrectomy in the SG group than in the TG group. No recurrence of gastric cancer was detected in the SG group during median follow-up of 99.2 months. ConclusionIn comparison to TG, limited SG surgery for ERGC improved the postoperative course, with no recurrence of cancer. Therefore, SG is a safe and effective treatment for ERGC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Limited subtotal gastrectomy for early remnant gastric cancer

et al. 2013

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“…Therefore, applying the indication of ESD for primary gastric cancer to RGC would be possible. Despite the reported success of ESD for RGC or GSC [8,16,17], ESD is also technically challenging in the remnant stomach. Even when the patient has an entire stomach, difficulty with enfacement and access to the lesion can increase the frequency of hemorrhage during and after ESD if the lesion is located in the upper third of the stomach [18].…”

Section: Discussionmentioning

confidence: 99%

“…There have been a few reports about ESD for gastric cancer on a stapler site: one case report described successful ESD of a gastric tube cancer that arose on a previous surgical staple line [19], and another suggested that en bloc ESD can be highly effective, despite the presence of staples, when performed by an experienced endoscopist [8]. These reports could support the technical possibility of ESD for RGC on a stapler site, but the technical feasibility of ESD for RGC on an anastomosis site, a stapler site, should be carefully considered.…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of LN metastasis, ESD offers the possibility of cure without the risks associated with a second oncological surgical procedure. Even though ESD has already been used to treat carcinoma in the remnant stomach [8][9][10], to date, there has been no decided indication of ESD for RGC because it had been uncommon and, consequently, there has been no report that reviewed a large amount of pathological results for RGC after CTG.…”

Section: Introductionmentioning

confidence: 99%

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Can we apply the same indication of endoscopic submucosal dissection for primary gastric cancer to remnant gastric cancer?

et al. 2013

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Background Currently, remnant gastric cancer (RGC) is uncommon compared with gastric stump cancer, but early detection of gastric cancer and improved postsurgical survival will lead to increased incidence of RGC. Therefore, the indication of endoscopic submucosal dissection (ESD) for RGC is now required, but there have been no reports about this because of the lack of information for RGC. Methods A retrospective review was conducted on 105 patients who underwent completion total gastrectomy (CTG) and 5 patients who underwent ESD for RGC between January 1998 and December 2010 at Yonsei University Hospital. Results Forty-one (39 %) of 105 patients were diagnosed with early RGC. Among these patients, 6 had an absolute indication for ESD, whereas 11 met expanded criteria for ESD. In these patients, there was no association between the severity of the former gastric cancer and the current RGC. Also, none of these 17 patients had LN metastasis after CTG, and only 1 (2.4 %) of 41 early RGC patients had LN metastasis. Median operative time was 216 min for CTG and median hospital stay was 8 days. There were two major and five minor complications. One splenectomy was performed because of injury that occurred during CTG. Conclusions Applying the indication of ESD for primary gastric cancer to RGC would be possible, and it could be an alternative treatment option for selected patients with RGC.

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