Surgical Resection of Remnant Gastric Cancer Following Distal Gastrectomy: A Retrospective Clinicopathological Study

Takahashi, Masashi; Takeuchi, Hiroya; Tsuwano, Shinichi; Nakamura, Rieko; Takahashi, Tsunehiro; Wada, Norihito; Kawakubo, Hirofumi; Saikawa, Yoshiro; Kitagawa, Yuko

doi:10.1245/s10434-015-4678-x

Cited by 24 publications

(16 citation statements)

References 42 publications

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“…This was expected because lymph node dissection had already been performed during the initial surgery in group M. In the current study, both groups showed the same incidence of lymph node metastasis. In previous reports, however, the incidence of lymph node metastasis was higher in group B [6,[18][19][20]. This could be explained by the fact that the number of remaining lymph Modified based on the extent of LN dissection for primary tumor according to the Japanese Gastric Cancer Treatment Guidelines and the Japanese Classification of Gastric Carcinoma a Lymph nodes dissected for D1: nos.…”

Section: Discussionmentioning

confidence: 94%

“…Together, these findings indicate that, despite progress in intensive therapies, the therapeutic outcomes for advanced CRS have hardly changed at all over the past 20 years. In a comparison of a more recent period with a prior period, Takahashi et al found a better survival rate in the more recent period [20]. These findings do not show an improvement in therapeutic outcomes, but they do indicate that better diagnostic abilities have increased the number of CRSs that are discovered early.…”

Section: Discussionmentioning

confidence: 97%

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Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach

et al. 2016

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Purpose In cases of carcinoma in the remnant stomach (CRS), the lymphatic flow may be altered by the initial surgery. In this study of CRS after gastrectomy, we investigated how the regions of lymph node metastasis and changes in lymphatic flow depend on initial disease status. Method The study included 76 patients with CRS who underwent gastrectomy between September 2002 and November 2014. We analyzed and compared the clinicopathological factors and survival periods between patients after distal gastrectomy for malignant disease (group M, 33 patients) and patients after distal gastrectomy for benign disease (group B, 43 patients).Results The depth of tumor invasion was more advanced in group B (T1/T2/T3/T4: group M 18/1/7/7, group B 8/11/ 8/16; P = 0.002). However, the degree of lymph node metastasis did not differ significantly between the two groups. The incidence of lymph node metastasis was high at stations 2 (19 %), 4sa (17 %), 10 (25 %), 11p (19 %), and 11d (27 %) in group M and 1 (14 %), 3 (23 %), and 4sb (15 %), and the mesojejunal lymph node (21 %) in group B. Lymph node dissection was highly beneficial at station 3, station 7, and the mesojejunum in both groups, but not at stations 10 or 11d.Conclusion As compared with group B, group M showed higher incidences of lymph node metastasis in the greater curvature, splenic hilum, and lymph nodes along the splenic artery, suggesting the predominance of lymphatic flows from the greater curvature to the splenic hilum and from the remnant stomach to the splenic artery.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach

et al. 2016

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“…Although the number of patients who undergo surgery for benign gastric diseases has been reduced, the early detection of PGC and improvements in the prognosis of PGC patients lead to an increase in the incidence of RGC . While the standardization of RGC surgery and the development of multiple adjuvant treatment therapies have improved the survival rate of RGC patients, the 5‐year survival rate of RGC patients is still 10%‐90% for those who have different tumor features, and as high as 27%‐36% of RGC patients relapse after surgery . To compare the survival of remnant gastric cancer (RGC) with primary gastric cancer, a systematic literature search was performed using PubMed with the keywords “remnant,” ‘‘stomach” and “cancer,” revealing 1065 relevant reports published up to the end of December 2018.…”

Section: Discussionmentioning

confidence: 99%

Conditional survival and recurrence of remnant gastric cancer after surgical resection: A multi‐institutional study

et al. 2019

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The present study was designed to evaluate the dynamic survival and recurrence of remnant gastric cancer (RGC) after radical resection and to provide a reference for the development of personalized follow-up strategies. A total of 298 patients were analyzed for their 3-year conditional overall survival (COS3), 3-year conditional disease-specific survival (CDSS3), corresponding recurrence and pattern changes, and associated risk factors. The 5-year overall survival (OS) and the 5-year disease-specific survival (DSS) of the entire cohort were 41.2% and 45.8%, respectively. The COS3 and CDDS3 of RGC patients who survived for 5 years were 84.0% and 89.8%, respectively. The conditional survival in patients with unfavorable prognostic characteristics showed greater growth over time than in those with favorable prognostic characteristics (eg, COS3, ≥T3: 46.4%-83.0%, Δ36.6% vs ≤T2: 82.4%-85.7%, Δ3.3%; P < 0.001). Most recurrences (93.5%) occurred in the first 3 years after surgery. The American Joint Committee on Cancer (AJCC) stage was the only factor that affected recurrence. Time-dependent Cox regression showed that for both OS and DSS, after 4 years of survival, the common prognostic factors that were initially judged lost their ability to predict survival (P > 0.05). Time-dependent logistic regression analysis showed that the AJCC stage | 503 CHEN Et al.

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“…Newly developed gastric cancer after partial gastrectomy for benign disease or gastric cancer is de ned as remnant gastric cancer or gastric stump cancer (GSC), which is found in 1.1-6% of patients [2][3][4][5][6]. Complete resection of the carcinoma combined with a radical lymph node dissection is the only way to secure curability and improve the prognosis in patients who have no other complications [7]. Mesenteric lymph node metastasis around the gastrojejunostomy may worsen the prognosis of GSC [5].…”

Section: Introductionmentioning

confidence: 99%

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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Surgical Resection of Remnant Gastric Cancer Following Distal Gastrectomy: A Retrospective Clinicopathological Study

Abstract: The prognosis of patients with RGC can be improved by aggressively performing curative resection without causing complications.

Cited by 24 publications

References 42 publications

Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach

Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach

Conditional survival and recurrence of remnant gastric cancer after surgical resection: A multi‐institutional study

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

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