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Surveillance Endoscopy Guidelines for Postgastrectomy Patients Based on Risk of Developing Remnant Gastric Cancer

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

Abstract

Background

Remnant gastric cancer (RGC) has a major impact on the long-term survival of postgastrectomy patients. In this study, we established surveillance endoscopy guidelines for postgastrectomy patients based on the risk of RGC.

Patients and Methods

A total of 6365 patients who underwent gastrectomy at Seoul St. Mary’s Hospital from September 2005 to June 2018 were retrospectively reviewed; 85 patients were identified as having RGC. We divided the RGC patients into subgroups according to the interval between primary and secondary gastrectomy.

Results

The curative resection rate was significantly lower in patients with an interval of ≤ 5 years versus > 5 years (p = 0.017). RGC developed more frequently after Billroth II reconstruction, and at the anastomotic site, in patients with a > 10- versus ≤ 10-year interval (p = 0.006 and p = 0.014, respectively). Similar results were observed based on the 15-year interval cutoff (p = 0.001 and 0.018, respectively). The 5-year overall survival rate of patients with a ≤ 5-year interval was significantly lower than that of patients with a > 5-year interval (60.0% versus 85.7%, p = 0.015), while overall survival did not differ between the ≤ 10- and > 10-year, or ≤ 15- and 15-year interval groups. RGC incidence showed a decrease after around 20 years postoperatively.

Conclusions

Thorough endoscopic examination should be conducted for up to 5 years postgastrectomy. Routine annual endoscopic follow-up should be performed for up to 20 years after the primary operation for gastric cancer, to allow for early detection of RGC.

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Acknowledgement

This research was supported by grants from the National Research Foundation of Korea (Grant Nos. 2018R1D1A1B07045486 and 2020R1A2C1012007) and the Korean Gastric Cancer Association. The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Hepatobiliary Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Eui Soo Han MD

  2. Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Ho Seok Seo MD, Ji Hyun Kim MD & Han Hong Lee MD, PhD

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  1. Eui Soo Han MD
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  2. Ho Seok Seo MD
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Han, E.S., Seo, H.S., Kim, J.H. et al. Surveillance Endoscopy Guidelines for Postgastrectomy Patients Based on Risk of Developing Remnant Gastric Cancer. Ann Surg Oncol 27, 4216–4224 (2020). https://doi.org/10.1245/s10434-020-08517-3

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  • DOI: https://doi.org/10.1245/s10434-020-08517-3

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