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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Funding

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

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Author notes

  1. Yudai Fukui and Junichi Shindoh have equally contributed to this work.

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon hospital, Tokyo, Japan

    Yudai Fukui MD, Junichi Shindoh MD, PhD, Aya Mizuno MD, Shusuke Haruta MD, PhD & Harushi Udagawa MD, PhD

  2. Division of Pathology, Toranomon hospital, Tokyo, Japan

    Naoko Inoshita MD, PhD

  3. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Shu Hoteya MD, PhD

  4. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Shigeru Tsunoda MD, PhD & Yoshiharu Sakai MD, PhD

  5. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Shin’ichi Miyamoto MD, PhD

  6. Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Rie Ozawa MD, Hirotaka Niwa MD, PhD & Hisashi Shinohara MD, PhD

Authors
  1. Yudai Fukui MD
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  2. Junichi Shindoh MD, PhD
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  3. Naoko Inoshita MD, PhD
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  4. Aya Mizuno MD
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  5. Shusuke Haruta MD, PhD
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  6. Harushi Udagawa MD, PhD
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  7. Shu Hoteya MD, PhD
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  8. Shigeru Tsunoda MD, PhD
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  9. Shin’ichi Miyamoto MD, PhD
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  10. Rie Ozawa MD
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  11. Hirotaka Niwa MD, PhD
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  12. Yoshiharu Sakai MD, PhD
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  13. Hisashi Shinohara MD, PhD
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Corresponding author

Correspondence to Hisashi Shinohara MD, PhD.

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Fukui, Y., Shindoh, J., Inoshita, N. et al. Efficacy of Endoscopic Management for Early Remnant Gastric Cancer: Is Completion Gastrectomy Truly Necessary in Cases with Marginally Noncurative Histopathologic Features?. Ann Surg Oncol 25, 1608–1615 (2018). https://doi.org/10.1245/s10434-018-6407-8

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  • DOI: https://doi.org/10.1245/s10434-018-6407-8

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