Efficacy of Endoscopic Management for Early Remnant Gastric Cancer: Is Completion Gastrectomy Truly Necessary in Cases with Marginally Noncurative Histopathologic Features?

  • Yudai Fukui
  • Junichi Shindoh
  • Naoko Inoshita
  • Aya Mizuno
  • Shusuke Haruta
  • Harushi Udagawa
  • Shu Hoteya
  • Shigeru Tsunoda
  • Shin’ichi Miyamoto
  • Rie Ozawa
  • Hirotaka Niwa
  • Yoshiharu Sakai
  • Hisashi Shinohara
Gastrointestinal Oncology
  • 27 Downloads

Abstract

Background

For patients with early primary gastric cancer, endoscopic management has become a standard of care. However, its efficacy for early remnant gastric cancer (ERGC) remains controversial and an invasive surgical procedure remains the primary choice of treatment.

Methods

A multi-institutional database of ERGC cases was retrospectively reviewed. Efficacy of endoscopic resection was analyzed by reviewing the clinicopathologic features of patients who underwent endoscopic resection and comparing the long-term outcomes with those of surgical resection.

Results

Of the 121 patients who were histopathologically diagnosed with ERGC after distal gastrectomy, 80 underwent endoscopic resection and 41 underwent completion gastrectomy (Group S). According to the histopathological criteria, 55 of the 80 endoscopic resection cases were classified as “curative resection” (Group E1) and the remaining 25 were classified as “noncurative resection” (Group E2). Tumor recurrence was observed only in three patients (12%) in Group E2, and no tumor recurrence was confirmed in Group S and Group E1. Multivariate analyses confirmed that completion gastrectomy [hazard ratio (HR), 6.2; 95% confidence interval (CI), 1.5–26.3] was associated with poor survival compared with endoscopic resection, and lymphovascular infiltration (HR 9.5; 95% CI 2.5–36.7) was correlated with tumor recurrence. Histopathological positive resection margin, tumor size, or deeper tumor invasion were not correlated with tumor recurrence after endoscopic resection.

Conclusions

Endoscopic management might be an effective treatment option for ERGC with potential long-term survival advantage over the completion gastrectomy even in cases with histopathological features, suggesting noncurative resection.

Notes

Funding

This study was supported by Japan society for the promotion of science Grant-in Aid for scientific Research Grant Number 16H05399.

Supplementary material

10434_2018_6407_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 kb)
10434_2018_6407_MOESM2_ESM.pdf (17 kb)
Supplementary material 2 (PDF 17 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Yudai Fukui
    • 1
  • Junichi Shindoh
    • 1
  • Naoko Inoshita
    • 2
  • Aya Mizuno
    • 1
  • Shusuke Haruta
    • 1
  • Harushi Udagawa
    • 1
  • Shu Hoteya
    • 3
  • Shigeru Tsunoda
    • 4
  • Shin’ichi Miyamoto
    • 5
  • Rie Ozawa
    • 6
  • Hirotaka Niwa
    • 6
  • Yoshiharu Sakai
    • 4
  • Hisashi Shinohara
    • 6
  1. 1.Department of Gastroenterological SurgeryToranomon hospitalTokyoJapan
  2. 2.Division of PathologyToranomon hospitalTokyoJapan
  3. 3.Department of GastroenterologyToranomon HospitalTokyoJapan
  4. 4.Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  5. 5.Department of Gastroenterology and Hepatology, Graduate School of MedicineKyoto UniversityKyotoJapan
  6. 6.Department of SurgeryHyogo College of MedicineNishinomiyaJapan

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