title: Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line.
  
  
  OBJECTIVE
  We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  National Cancer Center Hospital, Tokyo, Japan.
  
  
  METHODS
  We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011.
  
  
  METHODS
  We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival.
  
  
  RESULTS
  A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from EGC in the remnant stomach.
  
  
  CONCLUSIONS
  Single-center, retrospective study.
  
  
  CONCLUSIONS
  ESD for EGC in the remnant stomach of patients after gastrectomy was a feasible and effective therapeutic method and should become the standard treatment in such cases, based on the favorable long-term outcomes.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Nonaka
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Makomo
authors.initials: M
authors.lastname: Makazu
authors.forename: Shin
authors.initials: S
authors.lastname: Haruyama
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Yoshinaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kushima
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D004210:Dissection; D055088:Early Detection of Cancer; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D018530:Gastric Stump / Q000473:pathology* / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome