Endoscopic submucosal dissection for metachronous tumor in the remnant stomach after distal gastrectomy.
BACKGROUND
Endoscopic submucosal dissection (ESD) of tumor in the upper part of the stomach is technically difficult and has a high complication rate. We compared the feasibility and safety of ESD for metachronous tumor found in the remnant stomach after distal gastrectomy with ESD for tumor in the upper third of the intact stomach.


METHODS
We retrospectively compared clinical outcome and safety of 13 lesions (11 early gastric cancers (EGCs) and 2 dysplasias) in the remnant stomach and 30 lesions (28 EGCs and 2 dysplasias) in the upper third of the intact stomach. All patients were treated with ESD at a cancer center hospital.


RESULTS
En bloc resection rates were 100% (13/13) for remnant gastric tumor and 87% (26/30) for upper-third tumor (p = 0.30). En bloc resection rates with tumor-free margins (R0 resection) were 92% (12/13) for remnant gastric tumor and 73% (22/30) for upper-third tumor (p = 0.24). Curative resection rates were 85% (11/13) for remnant gastric tumor and 67% (20/30) for upper-third tumor (p = 0.29). Median procedure duration for ESD was 68 min (range 32-233 min) in the remnant stomach and 78 min (range 45-261 min) in the intact stomach (p = 0.49). One case of perforation and one of delayed bleeding occurred in the upper-third tumor group, whereas none occurred in the remnant tumor group. Local recurrence was found in no patients in the remnant gastric tumor group but in one patient in the upper-third tumor group.


CONCLUSIONS
ESD for metachronous remnant gastric tumor was feasible and safe in comparison with ESD for tumor in the upper third of the intact stomach.
Lee
Jong Yeul
JY
Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Choi
Il Ju
IJ
Cho
Soo-Jeong
SJ
Kim
Chan Gyoo
CG
Kook
Myeong-Cherl
MC
Lee
Jun Ho
JH
Ryu
Keun Won
KW
Kim
Young-Woo
YW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D018530:Gastric Stump; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome