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Surgical Endoscopy

, Volume 29, Issue 8, pp 2352–2358 | Cite as

Efficacy and long-term outcome of pre-emptive endoscopic resection and surgery for multiple synchronous gastric cancers

  • Masao Yoshida
  • Naomi KakushimaEmail author
  • Masanori Tokunaga
  • Masaki Tanaka
  • Kohei Takizawa
  • Kenichiro Imai
  • Kinichi Hotta
  • Hiroyuki Matsubayashi
  • Yutaka Tanizawa
  • Etsuro Bando
  • Taiichi Kawamura
  • Masanori Terashima
  • Hiroyuki Ono
Article
  • 187 Downloads

Abstract

Background

In cases of synchronous gastric cancers (SGC) that include one for surgical indication and another for endoscopic resection (ER) in two different regions of the stomach, patients can avoid total gastrectomy and undergo subtotal gastrectomy following successful pre-emptive ER. The aim of this study was to evaluate the feasibility and efficacy of pre-emptive endoscopic resection and surgery (PRES) with curative intent for such SGCs.

Methods

Between September 2002 and December 2012, 34 patients with SGCs (72 lesions) underwent PRES. Our institutional principals of PRES ensure the following: (1) treatment with curative intent, (2) multiple lesions indicated for ER and surgery, (3) evasion of TG following successful pre-emptive ER, (4) exclusion of type 4 and large type 3 (>80 mm) tumors, and (5) nonemergent cases such as hemorrhage, perforation, and obstruction. Clinicopathological characteristics and technical data were evaluated for all patients, and long-term outcomes were analyzed in patients who obtained curative ER and underwent subtotal gastrectomy.

Results

Curative ER was obtained in 31 patients (91.1 %), and subtotal gastrectomy was performed a median of 44 days after ER. Final stages were as follows: stage I, 25 patients (80.6 %); stage II, four patients (12.9 %); stage III, one patient (3.2 %); and stage IV, one patient (3.2 %). The 5-year overall and cause-specific survival rates were 96.3 % (95 % confidence interval 89.4–100 %) and 100 %, respectively.

Conclusions

PRES was feasible and effective as the first treatment of choice for multiple SGCs. PRES enables minimally invasive surgery with promising oncological outcomes.

Keywords

Gastric cancer Endoscopic resection Gastrectomy Minimally invasive surgery Quality of life 

Notes

Acknowledgments

The authors thank the SCC clinical trial management center (Mr. Keita Mori) for data management and helpful comments about statistics.

Disclosures

Masao Yoshida, Naomi Kakushima, Masanori Tokunaga, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Terashima, and Hiroyuki Ono have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Martin RCG, Jaques D, Brennan M, Karpeh M (2002) Achieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg 194:568–577PubMedCrossRefGoogle Scholar
  2. 2.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  3. 3.
    Kim AR, Cho J, Hsu YJ, Choi MG, Noh JH, Sohn TS, Bae JM, Yun YH, Kim S (2012) Changes of quality of life in gastric cancer patients after curative resection: a longitudinal cohort study in Korea. Ann Surg 256:1008–1013PubMedCrossRefGoogle Scholar
  4. 4.
    Jentschura D, Winkler M, Strohmeier N, Rumstadt B, Hagmüller E (1997) Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection. Hepatogastroenterology 44:1137–1142PubMedGoogle Scholar
  5. 5.
    Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, Barbul A (2005) Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 9:313–319PubMedCrossRefGoogle Scholar
  6. 6.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225PubMedCrossRefGoogle Scholar
  7. 7.
    Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498PubMedCrossRefGoogle Scholar
  8. 8.
    Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, Fujisaki J, Sano T, Yamaguchi T (2009) Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 12:148–152PubMedCrossRefGoogle Scholar
  9. 9.
    Rembacken BJ, Gotoda T, Fujii T, Axon AT (2001) Endoscopic mucosal resection. Endoscopy 33:709–718PubMedCrossRefGoogle Scholar
  10. 10.
    Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11PubMedCrossRefGoogle Scholar
  11. 11.
    Choi KS, Jung HY, Choi KD, Lee GH, Song HJ, Kim do H, Lee JH, Kim MY, Kim BS, Oh ST, Yook JH, Jang SJ, Yun SC, Kim SO, Kim JH (2011) EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 73:942–948PubMedCrossRefGoogle Scholar
  12. 12.
    Chiu PW, Teoh AY, To KF, Wong SK, Liu SY, Lam CC, Yung MY, Chan FK, Lau JY, Ng EK (2012) Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 26:3584–3591PubMedCrossRefGoogle Scholar
  13. 13.
    Everett SM, Axon AT (1997) Early gastric cancer in Europe. Gut 41:142–150PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Jang MY, Cho JW, Oh WG, Ko SJ, Han SH, Baek HK, Lee YJ, Kim JW, Jung GM, Cho YK (2013) Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection. Korean J Intern Med 28:687–693PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Kakushima N (2011) Endoscopic submucosal dissection using the insulated-tip knife. Tech Gastrointest Endosc 13:63–69CrossRefGoogle Scholar
  17. 17.
    Tanaka M, Ono H, Hasuike N, Takizawa K (2008) Endoscopic submucosal dissection of early gastric cancer. Digestion 77(Suppl 1):23–28PubMedCrossRefGoogle Scholar
  18. 18.
    Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, Tsujitani S, Seto Y, Furukawa H, Oda I, Ono H, Tanabe S, Kaminishi M (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 16:1–27PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Hosokawa O, Kaizaki Y, Watanabe K, Hattori M, Douden K, Hayashi H, Maeda S (2002) Endoscopic surveillance for gastric remnant cancer after early cancer surgery. Endoscopy 34:469–473PubMedCrossRefGoogle Scholar
  20. 20.
    Nozaki I, Hato S, Kobatake T, Ohta K, Kubo Y, Nishimura R, Kurita A (2014) Incidence of metachronous gastric cancer in the remnant stomach after synchronous multiple cancer surgery. Gastric Cancer 17:61–66PubMedCrossRefGoogle Scholar
  21. 21.
    Nonaka S, Oda I, Makazu M, Haruyama S, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Kushima R, Saito Y (2013) Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. Gastrointest Endosc 78:63–72PubMedCrossRefGoogle Scholar
  22. 22.
    Nishide N, Ono H, Kakushima N, Takizawa K, Tanaka M, Matsubayashi H, Yamaguchi Y (2012) Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube. Endoscopy 44:577–583PubMedCrossRefGoogle Scholar
  23. 23.
    Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, Doi T, Otani Y, Fujisaki J, Ajioka Y, Hamada T, Inoue H, Gotoda T, Yoshida S (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270PubMedCrossRefGoogle Scholar
  24. 24.
    Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 38:1001–1006PubMedCrossRefGoogle Scholar
  25. 25.
    Minami S, Gotoda T, Ono H, Oda I, Hamanaka H (2006) Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 63:596–601PubMedCrossRefGoogle Scholar
  26. 26.
    Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E (2014) Long-term outcomes of patients who underwent limited proximal gastrectomy. Gastric Cancer 17:141–145PubMedCrossRefGoogle Scholar
  27. 27.
    Karanicolas P, Graham D, Gönen M, Strong V, Brennan M, Coit D (2013) Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg 257:1039–1046PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Iwasaki Y, Sasako M, Yamamoto S, Nakamura K, Sano T, Katai H, Tsujinaka T, Nashimoto A, Fukushima N, Tsuburaya A (2013) Phase II study of preoperative chemotherapy with S − 1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). J Surg Oncol 107:741–745PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Masao Yoshida
    • 1
  • Naomi Kakushima
    • 1
    Email author
  • Masanori Tokunaga
    • 2
  • Masaki Tanaka
    • 1
  • Kohei Takizawa
    • 1
  • Kenichiro Imai
    • 1
  • Kinichi Hotta
    • 1
  • Hiroyuki Matsubayashi
    • 1
  • Yutaka Tanizawa
    • 2
  • Etsuro Bando
    • 2
  • Taiichi Kawamura
    • 2
  • Masanori Terashima
    • 2
  • Hiroyuki Ono
    • 1
  1. 1.Division of EndoscopyShizuoka Cancer CenterSunto-gunJapan
  2. 2.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan

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