Comparison of Endoscopic Submucosal Dissection and Radical Surgery for Early Gastric Cancer in Remnant Stomach

Abstract

(1) Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the remnant stomach or gastric tube is not yet widespread and few studies have compared the short-term and long-term outcomes with radical surgery. (2) Methods: A total of 73 consecutive patients with EGC in the remnant stomach or gastric tube who underwent ESD or radical surgery between October 2009 and October 2020 were retrospectively analyzed in this study. Baseline characteristics, post-operative complications, quality of life (QOL), recurrence rate, overall survival (OS) and disease-free survival (DFS) were compared between the ESD and surgery groups. (3) Results: Among the 73 patients with EGC in the remnant stomach or gastric tube, 48 (65.8%) underwent ESD and 25 (34.2%) underwent surgery. The operation time (p = 0.000) and post-operative hospital stay (p = 0.002) of the ESD group were significantly shorter than those in the surgery group. The incidence of post-operative complications in the ESD group was significantly lower than that in surgery group (p = 0.001). The ESD group had significantly better functional scale scores and lower rates of fatigue, pain, appetite loss, financial difficulties, dysphagia, eating restrictions, hair loss, and poor body image than the surgery group. There was no significant difference in OS or DFS between the ESD and surgery groups (p = 0.124 and 0.344, respectively). (4) Conclusion: ESD can significantly shorten the operation time and hospital stay, reduce surgical complications, and provide better QOL for patients with EGC in the remnant stomach or gastric tube, and its long-term prognosis is no shorter than that of radical surgery.

Gastric Conduit Cancer following Ivor-Lewis Esophagectomy for Esophageal Adenocarcinoma: A Case Report and Literature Review

“…Other studies have also demonstrated that gastric cancer in the gastric tube following esophagectomy is occasionally found, with an incidence of 1.0–7.0% and a 10-year cumulative incidence rate of gastric tube carcinoma (GTC) of 5.7% [ 8 , 9 ]. We have identified several factors contributing to the increased morbidity of this pathology.…”

“…Although gastric cancer in the remnant stomach or gastric tube is typically detected at an advanced stage and surgical resection of the total remnant stomach has been the standard treatment for a long time, radical resection of advanced disease is technically demanding and carries high surgical morbidity rates [ 5 , 8 , 9 , 12 ]. Currently, the detection of early gastric cancer (EGC) in the remnant stomach or gastric tube is increasing due to follow-up endoscopic surveillance programs.…”

“…Currently, the detection of early gastric cancer (EGC) in the remnant stomach or gastric tube is increasing due to follow-up endoscopic surveillance programs. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for treating EGC are less invasive than surgery, leading to a better quality of life [ 5 , 8 ]. The indications for EMR are the same as for gastric cancer: well-differentiated adenocarcinoma (grade 1); depth of invasion limited to the lamina propria; less than 1.0 cm in diameter; no ulceration [ 3 ].…”

“…The indications for EMR are the same as for gastric cancer: well-differentiated adenocarcinoma (grade 1); depth of invasion limited to the lamina propria; less than 1.0 cm in diameter; no ulceration [ 3 ]. These methods of treatment allow for complete resection and also provide curative resection for patients without lymph node metastasis [ 5 , 8 ]. Compared to conventional EMR procedures, ESD offers several advantages including the potential to achieve a higher complete resection rate.…”

“…incidence rate of gastric tube carcinoma (GTC) of 5.7% [8,9]. We have identified several factors contributing to the increased morbidity of this pathology.…”