Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube

Background and study aims: Little information exists regarding the optimal treatment of early gastric cancer (EGC) in a remnant stomach or gastric tube. The aim of this study was to assess the feasibility and clinical outcomes of endoscopic submucosal dissection (ESD) for EGC in a remnant stomach and gastric tube.

Patients and methods: Between September 2002 and December 2009, ESD was performed in 62 lesions in 59 patients with EGC in a remnant stomach (48 lesions) or gastric tube (14 lesions). Clinicopathological data were retrieved retrospectively to assess the en bloc resection rate, complications, and outcomes. Treatment results were assessed according to the indications for endoscopic resection, and were compared with those of ESD performed in a whole stomach during the same study period.

Results: The en bloc resection rates for lesions within the standard and expanded indication were 100 % and 93 %, respectively. Postoperative bleeding occurred in five patients (8 %). The perforation rate was significantly higher (18 %, 11 /62) than that of ESD in a whole stomach (5 %, 69 /1479). Among the perforation cases, eight lesions involved the anastomotic site or stump line, and ulcerative changes were observed in five lesions. The 3-year overall survival rate was 85 %, with eight deaths due to other causes and no deaths from gastric cancer.

Conclusion: A high en bloc resection rate was achieved by ESD for EGC in a remnant stomach or gastric tube; however, this procedure is still technically demanding due to the high complication rate of perforation.

• References

• 1 Ahn HS, Kim JW, Yoo MW et al. Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol 2008; 15: 1632-1639
• 2 Sugiura T, Kato H, Tachimori Y et al. Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy. J Am Coll Surg 2002; 194: 578-583
• 3 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
• 4 Tanaka M, Ono H, Hasuike N et al. Endoscopic submucosal dissection of early gastric cancer. Digestion 2008; 77: 23-28
• 5 Kakushima N, Ono H, Tanaka M et al. Endoscopic submucosal dissection using the insulated-tip knife. Tech Gastrointest Endosc 2011; 13: 63-69
• 6 Koyanagi K, Ozawa S, Ando N et al. Metachronous early gastric carcinoma in a reconstructed gastric tube after radical operation for oesophageal carcinoma. J Gastroenterol Hepatol 1998; 13: 311-315
• 7 Yoshida T, Fukuhara T, Inoue A et al. One-piece endoscopic resection of a gastric tube cancer on the surgical staple line. Gastrointest Endosc 2006; 63: 188-190
• 8 Bamba T, Kosugi S, Takeuchi M et al. Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy. Surg Endosc 2010; 24: 1310-1317
• 9 Lee JY, Choi IJ, Cho SJ et al. Endoscopic submucosal dissection for metachronous tumor in the remnant stomach after distal gastrectomy. Surg Endosc 2010; 24: 1360-1366
• 10 Hoteya S, Iizuka T, Kikuchi D et al. Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection. Dig Endosc 2010; 22: 17-20
• 11 Hirasaki S, Kanzaki H, Matsubara M et al. Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife. World J Gastroenterol 2008; 14: 2550-2555
• 12 Takenaka R, Kawahara Y, Okada H et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 2008; 67: 359-363
• 13 Osumi W, Fujita Y, Hiramatsu M et al. Endoscopic submucosal dissection allows less-invasive curative resection for gastric tube cancer after esophagectomy – a case series. Endoscopy 2009; 41: 777-780
• 14 Japanese Gastric Cancer Society Eds. Guidelines for diagnosis and treatment of carcinoma of the stomach. Tokyo, Japan: Kanehara Shuppan; 2010
• 15 Ono H, Hasuike N, Inui T et al. Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 2008; 11: 47-52
• 16 Oka S, Tanaka S, Kaneko I et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877-883
• 17 Kakushima N, Fujishiro M. Endoscopic submucosal dissection for gastrointestinal neoplasms. World J Gastroenterol 2008; 14: 2962-2967
• 18 Oda I, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 2005; 17: 54-58
• 19 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336