Long-term survival after endoscopic resection for early gastric cancer in the remnant stomach: comparison with radical surgery

Takeshi Yamashina; Noriya Uedo; Katsuyuki Dainaka; Kenji Aoi; Noriko Matsuura; Takashi Ito; Mototsugu Fujii; Takashi Kanesaka; Sachiko Yamamoto; Tomofumi Akasaka; Noboru Hanaoka; Yoji Takeuchi; Koji Higashino; Ryu Ishihara; Kentaro Kishi; Yoshiyuki Fujiwara; Hiroyasu Iishi

Authors Takeshi Yamashina, Noriya Uedo, Katsuyuki Dainaka, Kenji Aoi, Noriko Matsuura, Takashi Ito, Mototsugu Fujii, Takashi Kanesaka, Sachiko Yamamoto, Tomofumi Akasaka, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara, Kentaro Kishi, Yoshiyuki Fujiwara, Hiroyasu Iishi.

Abstract

Background Endoscopic resection (ER) has recently become standard treatment, even for early gastric cancer (EGC) in the remnant stomach. We aimed to compare long-term survival after ER versus radical surgery for EGC in the remnant stomach.

Methods We retrospectively compared overall and cause-specific survival of patients who had undergone ER or radical surgery for EGC in the remnant stomach from 1998 to 2012.

Results During the study period, 32 patients with intramucosal (M), two with shallow submucosal (SM1) and eight with deep submucosal (SM2) cancers had undergone ER (ER group) whereas six with M and seven with SM2 cancers had undergone surgery (surgery group). All patients were followed up for a median of 60 months; during follow up, 15 patients died, including three in the ER group with SM2 cancer who died of gastric cancer. The overall 5-year survival rates of M-SM1 and SM2 cancer patients in the ER and surgery groups were 89%, 48%, 80%, and 67%, respectively (P=0.079). The disease-specific 5-year survival rates of M-SM1 and SM2 cancer patients in the ER and surgery groups were 100%, 48%, 100%, and 100%, respectively (P=0.000). Operation time and hospital stay were significantly shorter in the ER than the surgery group (P<0.001). Grade 2 perforation occurred in two patients in the ER group and Grade 3 anastomotic leakage in two patients in the surgery group.

Conclusion ER provides excellent outcomes, comparable with those of radical surgery, in patients with M-SM1 gastric cancer in the remnant stomach; however, patients with SM2 cancer require radical surgery.

Keywords Early gastric cancer in the remnant stomach, long-term outcomes, endoscopic muosal resection, endoscopic submucosal dissection

Ann Gastroenterol 2015; 28 (1): 66-71