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The risk scoring system for assessing the technical difficulty of endoscopic submucosal dissection in cases of remnant gastric cancer after distal gastrectomy

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Abstract

Background

Endoscopic submucosal dissection (ESD) for remnant gastric cancer (RGC) after distal gastrectomy (DG) is considered technically challenging due to the narrow working space, and severe fibrosis and staples from the previous surgery. Technical difficulties of ESD for RGC after DG have not been thoroughly investigated. This study aimed to develop and validate a risk-scoring system for assessing the technical difficulty of ESD for RGC after DG in a large multicenter cohort.

Methods

We investigated patients who underwent ESD for RGC after DG in 10 institutions between April 2008 and March 2018. A difficult case was defined as ESD lasting ≥ 120 min, involving piecemeal resection, or the occurrence of perforation during the procedure. A risk-scoring system for the technical difficulty of the procedure was developed based on multiple logistic regression analyses, and its performance was internally validated using bootstrapping.

Results

A total of 197 consecutive patients with 201 lesions were analyzed. There were 90 and 111 difficult and non-difficult cases, respectively. The scoring model consisted of four independent risk factors and points of risk scores were assigned for each as follows: tumor size > 20 mm: 2 points; anastomosis site: 2 points; suture line: 1 point; and non-expert endoscopist: 2 points. The C-statistics of the scoring system for technical difficulty was 0.72.

Conclusions

We developed a validated risk-scoring model for predicting the technical difficulty of ESD for RGC after DG that can contribute to its safer and more reliable performance.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

    Article  CAS  Google Scholar 

  2. Choi KS, Jun JK, Suh M et al (2015) Effect of endoscopy screening on stage at early gastric cancer diagnosis: results of the national cancer screening programme in Korea. Br J Cancer 112:608–612

    Article  CAS  Google Scholar 

  3. Hamashima C, Ogoshi K, Okamoto M et al (2013) A community based, case–control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. PLoS ONE 8:e79088

    Article  Google Scholar 

  4. Balfour DC (1922) Factors influencing the life expectancy of patients operated on for gastric ulcer. Ann Surg 76:405–408

    Article  CAS  Google Scholar 

  5. Fisher SG, Davis F, Nelson R et al (1993) A cohort study of stomach cancer risk in men after gastric surgery for benign disease. J Natl Cancer Inst 85:1303–1310

    Article  CAS  Google Scholar 

  6. Toftgaard C (1989) Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg 210:159–64

    Article  CAS  Google Scholar 

  7. Ahn HS, Kim JW, Yoo MW et al (2008) Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol 15:1632–1639

    Article  Google Scholar 

  8. Irino T, Hiki N, Ohashi M et al (2016) Characteristics of gastric stump cancer: a single hospital retrospective analysis of 262 patients. Surgery 159:1539–1547

    Article  Google Scholar 

  9. Nakagawa M, Choi YY, An JY et al (2016) Staging for remnant gastric cancer: the metastatic lymph node ratio vs. the UICC 7th edition system. Ann Surg Oncol 23:4322–4331

    Article  Google Scholar 

  10. Hanyu T, Wakai A, Ishikawa T et al (2018) Carcinoma in the remnant stomach during long-term follow-up after distal gastrectomy for gastric cancer: analysis of cumulative incidence and associated risk factors. World J Surg 42:782–787

    Article  Google Scholar 

  11. Ikeda Y, Saku M, Kishihara F et al (2005) Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer. Br J Surg 92:235–239

    Article  CAS  Google Scholar 

  12. Onodera H, Tokunaga A, Yoshiyuki T et al (2004) Surgical outcome of 483 patients with early gastric cancer: prognosis, postoperative morbidity and mortality, and gastric remnant cancer. Hepatogastroenterology 51:82–85

    PubMed  Google Scholar 

  13. Nozaki I, Nasu J, Kubo Y et al (2010) Risk factors for metachronous gastric cancer in the remnant stomach after early cancer surgery. World J Surg 34:1548–1554

    Article  Google Scholar 

  14. Tanaka M, Ono H, Hasuike N et al (2008) Endoscopic submucosal dissection of early gastric cancer. Digestion 77:23–28

    Article  Google Scholar 

  15. Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11

    Article  Google Scholar 

  16. Ono H, Kondo H, Gotoda T et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  CAS  Google Scholar 

  17. Choi IJ, Lee JH, Kim YI et al (2015) Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. Gastrointest Endosc 81:333–341

    Article  Google Scholar 

  18. Hoteya S, Iizuka T, Kikuchi D et al (2010) Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection. Dig Endosc 22:17–20

    Article  Google Scholar 

  19. Hirasaki S, Kanzaki H, Matsubara M et al (2008) Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife. World J Gastroenterol 14:2550–2555

    Article  Google Scholar 

  20. Takenaka R, Kawahara Y, Okada H et al (2008) Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 67:359–363

    Article  Google Scholar 

  21. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  22. Yano T, Hasuike N, Ono H et al (2020) Factors associated with technical difficulty of endoscopic submucosal dissection for early gastric cancer that met the expanded indication criteria: post hoc analysis of a multi-institutional prospective confirmatory trial (JCOG0607). Gastric Cancer 23:168–174

    Article  CAS  Google Scholar 

  23. Toyonaga T, Man-I M, Fujita T et al (2010) The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study. Aliment Pharmacol Ther 32:908–915

    Article  CAS  Google Scholar 

  24. Sullivan LM, Massaro JM, D’Agostino RB (2004) Presentation of multivariate data for clinical use: the Framingham Study risk score function. Stat Med 23:1631–1660

    Article  Google Scholar 

  25. Chung IK, Lee JH, Lee SH et al (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235

    Article  Google Scholar 

  26. Kim M, Jeon SW, Cho KB et al (2013) Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Daegu-Kyungpook Gastrointestinal Study Group (DGSG). Surg Endosc 27:1372–8

    Article  Google Scholar 

  27. Littler ER, Gleibermann E (1972) Gastritis cystica polyposa. (Gastric mucosal prolapse at gastroenterostomy site, with cystic and infiltrative epithelial hyperplasia). Cancer 29:205–9

    Article  CAS  Google Scholar 

  28. Yabuuchi Y, Kakushima N, Takizawa K et al (2019) Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. J Gastroenterol 54:511–520

    Article  Google Scholar 

  29. Tanaka S, Toyonaga T, Morita Y et al (2014) Endoscopic submucosal dissection for early gastric cancer in anastomosis site after distal gastrectomy. Gastric Cancer 17:371–376

    Article  Google Scholar 

  30. Suzuki H, Takizawa K, Hirasawa T et al (2019) Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: “real-world evidence” in Japan. Dig Endosc 31:30–39

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the many institutional faculty involved in this study.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Chu-o-ku, Kusunoki-Cho, Kobe, Hyogo, 650-0017, Japan

    Shinwa Tanaka, Hirofumi Abe, Toshitatsu Takao, Yoshinori Morita, Takashi Toyonaga & Yuzo Kodama

  2. Department of Gastroenterology, Saiseikai Nakatsu Hospital, Osaka, Japan

    Tetsuya Yoshizaki

  3. Department of Gastroenterology, Hyogo Cancer Center, Akashi, Japan

    Yoshinobu Yamamoto

  4. Department of Gastroenterology, Kita-Harima Medical Center, Ono, Japan

    Takayuki Ose

  5. Department of Gastroenterology, Akashi Medical Center, Akashi, Japan

    Tsukasa Ishida

  6. Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan

    Yasuaki Kitamura

  7. Department of Gastroenterology, Kobe Red Cross Hospital, Kobe, Japan

    Daisuke Obata

  8. Department of Gastroenterology, Sano Hospital, Kobe, Japan

    Mineo Iwatate, Mikio Fujita & Yasushi Sano

  9. Department of Gastroenterology, Sanda City Hospital, Sanda, Japan

    Atsushi Ikeda

  10. Department of Gastroenterology, Steel Memorial Hirohata Hospital, Himeji, Japan

    Ryusuke Ariyoshi

  11. Department of Gastroenterology, Konan Medical Center, Kobe, Japan

    Fumiaki Kawara

  12. Division of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan

    Eiji Umegaki

  13. Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan

    Hogara Nishisaki

Authors
  1. Shinwa Tanaka
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  2. Tetsuya Yoshizaki
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  4. Takayuki Ose
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  6. Yasuaki Kitamura
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  13. Hirofumi Abe
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  15. Yoshinori Morita
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  16. Yasushi Sano
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  17. Eiji Umegaki
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  18. Hogara Nishisaki
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  19. Takashi Toyonaga
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  20. Yuzo Kodama
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Corresponding author

Correspondence to Shinwa Tanaka.

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Disclosures

Dr Takashi Toyonaga has no conflicts of interest, but has royalities of Olympus and FUJIFILM. Drs. Shinwa Tanaka, Tetsuya Yoshizaki, Yoshinobu Yamamoto, Takayuki Ose, Tsukasa Ishida, Yasuaki Kitamura, Daisuke Obata, Mineo Iwatate, Mikio Fujita, Atsushi Ikeda, Ryusuke Ariyoshi, Fumiaki Kawara, Hirofumi Abe, Toshitatsu Takao, Yoshinori Morita, Yasushi Sano, Eiji Umegaki, Hogara Nishisaki,, Yuzo Kodama have no conflicts of interest or financial ties to disclose.

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Tanaka, S., Yoshizaki, T., Yamamoto, Y. et al. The risk scoring system for assessing the technical difficulty of endoscopic submucosal dissection in cases of remnant gastric cancer after distal gastrectomy. Surg Endosc 36, 1482–1489 (2022). https://doi.org/10.1007/s00464-021-08433-x

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  • DOI: https://doi.org/10.1007/s00464-021-08433-x

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