Short- and Long-term Outcomes of Surgical Treatment for Remnant Gastric Cancer After Distal Gastrectomy

Nakaji, Yu; Saeki, Hiroshi; Kudou, Kensuke; Nakanishi, Ryota; Shimada, Masahiko; Nakashima, Yasuhiro; Ando, Koji; Oda, Yoshinao; Oki, Eiji; Maehara, Yoshihiko

doi:10.21873/anticanres.13256

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Many surgeons have successfully applied LCTG, and this technique is considered the preferred treatment option (Table 5) [24][25][26][27][28][29][30][31][32][33]. As shown in Table 6, our results are consistent with those of comparative studies [14][15][16][17][18][19][20][21]. The patients in the LCTG group had smaller tumor size, lower numbers of metastatic lymph nodes, and lower pathological stages than patients in the OCTG group; however, the clinical stage distribution, dissection, and retrieved lymph nodes showed no signi cant differences between the groups.…”

Section: Discussionsupporting

confidence: 85%

“…The patients in the LCTG group had smaller tumor size, lower numbers of metastatic lymph nodes, and lower pathological stages than patients in the OCTG group; however, the clinical stage distribution, dissection, and retrieved lymph nodes showed no signi cant differences between the groups. Additionally, the number of retrieved lymph nodes was equal to that reported in other studies (Table 6) [14][15][16][17][18][19][20][21]. The OCTG group had a higher number of recurrences and deaths than the LCTG group, because the OCTG group had more advanced cases, leading to a worse 5-year overall survival rate than the LCTG group.…”

Section: Discussionmentioning

confidence: 52%

“…Laparoscopic gastrectomy has been con rmed to be safe with improved postoperative pain and earlier recovery than open gastrectomy [11][12][13]. However, only a few studies have reported the feasibility of laparoscopic completion total gastrectomy (LCTG) for GSC [14][15][16][17][18][19][20][21]. This study aimed to evaluate the feasibility, safety, and clinical outcomes of LCTG compared with those of open completion total gastrectomy (OCTG) to prove the oncological validity of LCTG.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Completion total Gastrectomy as an Alternative Procedure for Gastric Stump Cancer: A Case Control Study

Takahashi

Inaki

Saito

et al. 2020

Preprint

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BackgroundComplete gastrectomy for gastric stump cancer can be challenging due to severe adhesions; therefore, advanced techniques are required to perform laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy for the treatment of gastric stump cancer.MethodsPatient records from January 2010 to October 2018 were retrospectively evaluated. The patients were divided into two groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data; survival rates; and prognosis between the groups.ResultsTwenty open and 17 laparoscopic completion total gastrectomies were performed. No significant differences in the distribution of the clinical T and N categories, clinical stage, and reconstruction methods of the initial gastrectomy between the two groups were observed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 vs. 182.5 min; p = 0.026), lower blood loss (14 vs. 105 mL; p = 0.0000179), and shorter period to the first flatus passage (2 vs. 3 days; p = 0.0000401) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the two groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathological findings revealed that the laparoscopic group had a smaller tumor size (not pathological T category) and less metastatic lymph nodes than the open group; this led to an earlier distribution of the pathological stage and better overall or disease-free survivals in the laparoscopic group.ConclusionsLaparoscopic completion total gastrectomy was safely conducted without complications and mortality implicating the oncological validity for the treatment of gastric stump cancer. With sophistication of laparoscopic skills and advanced technologies, laparoscopic completion total gastrectomy may be the best way to perform less invasive surgery in terms of decreased blood loss and earlier recovery of intestinal peristalsis.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Completion total Gastrectomy as an Alternative Procedure for Gastric Stump Cancer: A Case Control Study

Takahashi

Inaki

Saito

et al. 2020

Preprint

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“…After distal gastrectomy, Billroth II reconstruction is the most common reconstruction performed worldwide. In the past, the number of gastric resections, especially for benign pathologies such as gastric ulcers, was higher, so today, we can observe a certain number of gastric carcinoma arising at the anastomotic site, that is, gastric stump cancer [1,2]. The case reported in this article demonstrates the use of minimally invasive technology to remove a remnant stomach that is tenaciously embedded by adhesions and how to perform the reconstruction of the digestive tract.…”

Section: Introductionmentioning

confidence: 85%

Completion total gastrectomy with intracorporeal robot-sewn esophago-jejunal anastomosis

Carafa

Valle²,

Méméo

et al. 2020

Journal of Gastric Surgery

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Many technical reports concern minimally invasive surgery for stomach cancer; however, there is poor evidence about employing this approach for gastric stump cancer, which can arise at the anastomotic site in patients who have undergone previous partial gastrectomy for benign diseases such as gastric ulcer. Such surgery was quite common before the introduction of proton pump inhibitors (PPIs), and so today, according to different statistics, gastric stump cancer can be revealed in up to 8% of these patients. This report seeks to highlight the possibility of employing a minimally invasive approach in patients who already had an operation for gastric resection. The video shows technical notes about the hybrid laparoscopic-robotic approach performed in a patient who previously underwent open distal gastrectomy. Is the previous laparotomy an absolute or relative counterindication to reperform a surgery through a minimally invasive approach?

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“…In terms of the postoperative complication rate, five of the ten studies reported a 6.5%–23.3% risk reduction with LG compared to that of OG[60,62,64,65,68]. The remaining five studies showed unfavorable results from the laparoscopic approach in terms of the postoperative mortality rate, although the result was not statistically significant[61,63,66,67,69]. LG was also associated with a significantly shorter postoperative hospital stay than OG, as shown in one of the non-RCTs.…”

Section: Laparoscopic Gastrectomy For Remnant Gastric Cancermentioning

confidence: 99%

Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?

Líu

et al. 2019

WJCC

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The incidence of remnant gastric cancer (RGC) is still increasing. Minimally invasive approaches including endoscopic resection, laparoscopic and robotic approaches, and function-preserving gastrectomy have been utilized as curative treatment methods for primary gastric cancer. However, adhesions and anatomical alterations due to previous gastrectomy make the use of minimally invasive approaches complicated and difficult for RGC. Application of these approaches for the treatment of RGC is still controversial. Endoscopic submucosal dissection is a favorable alternative therapy for the resection of early gastric cancer that occurs in the remnant stomach and can prevent unnecessary complications. The majority of retrospective studies have shown that endoscopic submucosal dissection is an effective and oncologically safe treatment modality for RGC. Subtotal gastrectomy could serve as a function-preserving gastrectomy for patients with early RGC and improve postoperative late-phase function. However, there are only two studies that demonstrate the feasibility and oncological efficacy of subtotal gastrectomy for RGC. The non-randomized controlled trials showed that compared to open gastrectomy, laparoscopic gastrectomy for RGC led to better short-term outcomes and similar oncologic results. Because of the rarity of RGC, future multicenter studies are required to determine the indications of minimally invasive treatment for RGC.

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Short- and Long-term Outcomes of Surgical Treatment for Remnant Gastric Cancer After Distal Gastrectomy

Cited by 8 publications

References 14 publications

Laparoscopic Completion total Gastrectomy as an Alternative Procedure for Gastric Stump Cancer: A Case Control Study

Laparoscopic Completion total Gastrectomy as an Alternative Procedure for Gastric Stump Cancer: A Case Control Study

Completion total gastrectomy with intracorporeal robot-sewn esophago-jejunal anastomosis

Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?

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