Evaluating the Need for Additional Surgery After Non-Curative Endoscopic Resection in Patients with Remnant Gastric Cancer.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2025-03-17 DOI:10.1007/s12029-025-01199-8

Tatsunori Minamide, Hiroyuki Ono, Noboru Kawata, Yuki Maeda, Masao Yoshida, Yoichi Yamamoto, Kazunori Takada, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Junya Sato, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Akifumi Notsu, Etsuro Bando

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引用次数: 0

Abstract

Purpose: Completion total gastrectomy is considered an additional treatment after non-curative endoscopic resection for remnant gastric cancer. However, its high invasiveness remains a concern. This study aimed to assess the necessity of additional surgery after non-curative endoscopic submucosal dissection in patients with remnant gastric cancer.

Methods: This study included patients who underwent non-curative endoscopic submucosal dissection for remnant gastric cancer between September 2002 and January 2018. The eCura system was used to stratify the risk of lymph node metastasis into low, intermediate, or high. The overall survival, disease-specific survival, and long-term clinical course were analyzed.

Results: Among the 46 patients analyzed, 15 underwent additional completion total gastrectomy, whereas 31 were only followed up. Within a median follow-up period of 62.5 months, the additional surgery and follow-up groups showed 5-year overall survival rates of 79.4% and 76.8% (P = 0.93) and disease-specific survival rates of 92.9% and 92.7% (P = 0.98). A total of 19 low-, 8 intermediate-, and 4 high-risk patients in the follow-up group achieved 5-year disease-specific survival rates of 100%, 100%, and 33.3%. Significant differences were observed in the disease-specific survival between the low- and high-risk patients (P < 0.001) and between the intermediate- and high-risk patients (P = 0.02).

Conclusion: Risk stratification using the eCura system allows for individualized treatment decisions, with follow-up being a viable option for low- and intermediate-risk patients and additional surgery recommended for high-risk patients after non-curative endoscopic submucosal dissection for remnant gastric cancer.

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评估残胃癌患者非治愈性内镜切除后额外手术的必要性。

目的：完全性全胃切除术被认为是残胃癌非根治性内镜切除后的补充治疗。然而，它的高侵入性仍然是一个问题。本研究旨在评估残余胃癌患者在内镜下粘膜下剥离后进行额外手术的必要性。方法：本研究纳入2002年9月至2018年1月期间接受非治愈性内镜下粘膜下清扫术的残胃癌患者。eCura系统用于将淋巴结转移风险分为低、中、高三个等级。分析总生存期、疾病特异性生存期和长期临床病程。结果：在分析的46例患者中，15例追加完成全胃切除术，31例仅随访。在62.5个月的中位随访期内，额外手术组和随访组5年总生存率分别为79.4%和76.8% (P = 0.93)，疾病特异性生存率分别为92.9%和92.7% （P = 0.98）。随访组低危19例，中危8例，高危4例，5年疾病特异性生存率分别为100%、100%、33.3%。结论：使用eCura系统进行风险分层可以做出个性化的治疗决定，对于低危和中危患者，随访是一个可行的选择，对于残胃癌内镜下粘膜下夹层切除术后的高危患者，建议进行额外的手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.