K. Tokizawa1, H. Takeuchi1, M. Inoue1, M. Takahashi1, K. Fukuda1, R. Nakamura1, K. Suda1, N. Wada1, H. Kawakubo1, Y. Kitagawa1 1Keio University School Of Medicine,Department Of Surgery,Shinjuku-ku, TOKYO, Japan
Introduction: To evaluate the adequacy of endoscopic treatment for remnant gastric cancer (RGC), we investigated the clinicopathological characteristics and the accuracy of preoperative prediction of the invasion depth of RGC.
Methods: We retrospectively surveyed 100 RGC patients who underwent surgical resection or endoscopic treatment in Keio University Hospital between January 2000 and June 2016.
Results: During the mentioned-above period, 75 patients with RGC underwent gastrectomy and 34 patients underwent endoscopic treatment, nine of whom underwent additional surgical resection after non-curative endoscopic treatment. Initial gastric diseases included benign (22 patients, 22.0%) and malignant diseases (78 patients, 78.0%). Reconstructions by initial surgery included Billroth I (69 patients, 69.0%), Billroth II (15 patients, 15.0%), and Roux-en-Y (one patient, 1.0%). Fifteen patients (15.0%) had underwent procedures other than distal gastrectomy. Among 85 cases with RGC following distal gastrectomy, the pathological depth of invasion was confined to the mucosa (M; 30 patients, 35.5%), submucosa (SM; 26 patients, 30.6%), muscularis propia (MP; 7 patients, 8.2%), subserosa (SS; 8 patients, 9.4%), and serosa-exposed (SE; 14 patients, 16.5%). In cases of pathological M, SM and MP, 41 patients (65.1%) had been properly diagnosed before the treatment. Preoperative prediction of the invasion depth was more invasive than pathological diagnosis in 9 patients (14.3%) and less invasive in 13 patients (20.6%). The accuracy rate was apt to be lower in anastomotic sites than in nonanastomotic sites (47.1% vs 71.7%, p = 0.065). Five-year survival rate in pathological stage I patients was not significantly different between patients who underwent endoscopic treatment and those who underwent surgical resection.
Conclusion: Endoscopic treatment may be reasonable option for early RGC. However, it requires careful consideration since there are still difficulties in making accurate preoperative prediction of the invasion depth of RGC.