Different risks of nodal metastasis by tumor location in remnant gastric cancer after curative gastrectomy for gastric cancer

Abstract

Background Curative surgery for remnant gastric cancer (RGC) after gastrectomy for gastric cancer (GC) can be challenging. We examined the risk factors for lymph node metastasis in RGC, especially for tumors located at the greater curvature (G) or non-greater curvature (NG), to determine the appropriate indications of curative surgery. Methods Data from the two high-volume centers of Japan between 1998 and 2018 were retrospectively reviewed. Among the 137 patients enrolled in this study, 34 were classified as the G group and 103 as the NG group. The incidence of lymph node metastasis and its risk factors was evaluated. Results Lymph node metastasis was observed in 21.2% (29/137), including 38.2% (13/34) in the G group and 15.5% (16/103) in the NG group (p = 0.008). A logistic regression analysis showed that tumor location of G or NG (p = 0.042), tumor size (p = 0.002) and depth of invasion (p = 0.009) were significant independent risk factors for nodal metastasis. Risk classification using these factors showed that clinical T1-T2 with a maximum size < 35 mm located at the non-greater curvature had the lowest nodal metastatic risk (4.3%). Conclusions Tumor location at the G or NG was a significant risk factor for nodal metastasis in RGC. When selecting curative surgery for RGC, physicians should consider the nodal metastatic risk calculated by the tumor location, size and depth of invasion.

The epigenetic modifier lysine methyltransferase 2C is frequently mutated in gastric remnant carcinoma

“…Gastric remnant carcinoma (GRC) is a relatively rare malignancy that develops in the remnant stomach after partial gastrectomy, regardless of the initial pathology or reconstruction technique [ 1 ]. GRC has an incidence of 1–5% after gastrectomy.…”

Evaluating the optimal treatment strategy for early and advanced remnant gastric cancer

“…[7][8][9][10] This could change the importance of LN dissection and the prognostic influence of LN dissection for RGC. 3,11,12 For early RGC, is it justifiable to use current criteria of additional gastrectomy after endoscopic submucosal dissection (ESD) [13][14][15] ? For advanced RGC, is it really expected to perform splenectomy and jejunal LN dissection?…”

“…It is known that many RGC cases are affected by the initial gastrectomy, especially in terms of lymph node (LN) status 7–10 . This could change the importance of LN dissection and the prognostic influence of LN dissection for RGC 3,11,12 . For early RGC, is it justifiable to use current criteria of additional gastrectomy after endoscopic submucosal dissection (ESD) 13–15 ?…”