Endoscopic Submucosal Dissection for Early Gastric Neoplasia Occurring in the Remnant Stomach after Distal Gastrectomy

Lee, Ji Young; Min, Byung Hoon; Lee, Jung‐Kyu; Noh, Donghyo; Lee, Jun Haeng; Rhee, Poong–Lyul; Kim, Jae J

doi:10.5946/ce.2015.049

Cited by 11 publications

(15 citation statements)

References 12 publications

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“…This is consistent with previous results indicating the absence of recurrence during a median follow-up of 47.5 months [11] and a 3-year overall survival rate of 85%, with 8 deaths due to other causes and none due to gastric cancer [13]. Considering the high postoperative mortality (19%–41%) after radical total gastrectomy for cancer in the remnant stomach [24, 25] and the favorable long-term outcomes in our study, ESD appears to be an attractive alternative to completion total gastrectomy, irrespective of the type of previous gastrectomy.…”

Section: Discussionsupporting

confidence: 94%

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Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

Song

Kim

Lee

et al. 2017

Gastroenterology Research and Practice

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Aims To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.

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Section: Discussionsupporting

confidence: 94%

“…Similarly, in the present study, perforation occurred in 1 patient whose lesion involved the suture lines. Overall, the perforation rate was only 3%, which is similar to rates reported previously (1.4%–5.6%) [10, 11]. This can be explained by the low number of lesions involving the suture lines, in the present study.…”

Section: Discussionsupporting

confidence: 90%

Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

Song

Kim

Lee

et al. 2017

Gastroenterology Research and Practice

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“…Referring to other studies reported in Korea, the number of metachronous adenomas and cancers after DG was 18 and 12 (however, in this study, the incidence of metachronous neoplasms could not be identified since only cases treated with endoscopic submucosal dissection were collected). 45 And Kim et al 37 reported that the incidence of metachronous neoplasms after endoscopic treatment for gastric dysplasia was 11.0%, and the number of metachronous adenomas and cancers was 24 (18 low-grade adenomas and six high-grade adenomas) and three, respectively. Although the number of MGNs in patients received surgery might be smaller due to the decreased area of the remnant stomach after surgery, the ratio of adenoma and cancer could be similar.…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Risk Factors for Metachronous Gastric Cancer in the Remnant Stomach after Gastric Cancer Surgery

et al. 2022

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Background/Aims Less invasive surgical treatment is performed in East Asia to preserve postoperative digestive function and reduce complications such as postgastrectomy syndromes, but there is an issue of metachronous gastric cancer (GC) in the remaining stomach. This study aimed to analyze the incidence of metachronous GC and its risk factors in patients who had undergone partial gastrectomy. Methods A total of 3,045 GC patients who had undergone curative gastric partial resection at Seoul National University Bundang Hospital were enrolled and analyzed retrospectively for risk factors, including age, sex, smoking, alcohol, Helicobacter pylori status, family history of GC, histological type, and surgical method. Results Metachronous GC in the remaining stomach occurred in 35 of the 3,045 patients (1.1%) 23 in the distal gastrectomy group (18 with Billroth-I anastomosis, five with Billroth-II anastomosis), seven in the proximal gastrectomy (PG) group, and five in the pylorus-preserving gastrectomy (PPG) group. Univariate and multivariate Cox regression analyses showed that age ≥60 years (p=0.005) and surgical method used (PG or PPG, p<0.001) were related risk factors for metachronous GC, while male sex and intestinal type histology were potential risk factors. Conclusions Metachronous GC was shown to be related to older age and the surgical method used (PG or PPG). Regular and careful follow-up with endoscopy should be performed in the case of gastric partial resection, especially in patients with male sex and intestinal type histology as well as those aged ≥60 years undergoing the PG or PPG surgical method.

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“…The most important step of these operations is to pull out the ANs. Unlike forcibly extracting the ANs using alligators or forceps in ESD for early gastric remnant cancer or colorectal MECPL emerging at the AS reported in the previous studies (8,9,18,25,26), the key and innovative point of our method is to integrate the nail and electrical knife by means of the electrical conduction effect (see in Figure 1B). Then, the submucosal tissue can be stripped around the ANs step by step, and finally, the ANs can be gently and successfully pulled out (see in Figure 1C).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of endoscopic submucosal dissection for metachronous early cancer or precancerous lesions emerging at the anastomotic site after curative surgical resection of colorectal cancer

et al. 2020

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Background: The incidence of metachronous early cancer or precancerous lesions (MECPL) emerging at the anastomotic site (AS) after curative surgical resection of colorectal cancer (CRC) is so low that few study have been conducted to explore the clinical characteristics, diagnosis and treatment of these lesions.Endoscopic submucosal dissection (ESD) is technically difficult for these lesions because of the presence of severe fibrosis and AS. The aim of this study was to explore the safety and efficacy of ESD for MECPL emerging at the AS after curative surgical resection of CRC.Methods: The data used in the analysis were retrospectively collected from CICAMS in Beijing China between January 2013 and May 2019 and from all the patients who underwent ESD for MECPL emerging at the AS after curative surgical resection of CRC. The rates of en bloc resection (ER), complete resection (CR), curative resection (CuR) and incidence of complications were analyzed by SPSS software.Results: A total of 11 patients were included. The rates of ER, CR and CuR were 63.6%, 54.5% and 54.5%, respectively. No additional surgery was performed, and no recurrences were found. Bleeding occurred in only one case and there was no perforation after the operation.Conclusions: Overall, ESD is safe and effective in the treatment of MECPL emerging at the AS after curative surgical resection of CRC. Especially for patients with anastomotic recurrence close to anal margin, this method can avoid the risks of reoperation and improve the rate of anal preservation.

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Endoscopic Submucosal Dissection for Early Gastric Neoplasia Occurring in the Remnant Stomach after Distal Gastrectomy

Cited by 11 publications

References 12 publications

Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

The Incidence and Risk Factors for Metachronous Gastric Cancer in the Remnant Stomach after Gastric Cancer Surgery

Safety and efficacy of endoscopic submucosal dissection for metachronous early cancer or precancerous lesions emerging at the anastomotic site after curative surgical resection of colorectal cancer

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