Journal of Gastric Cancer

  • 제24권3호
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  • Pages.280-290
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  • 2024
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Characteristics of Metachronous Remnant Gastric Cancer After Proximal Gastrectomy: A Retrospective Analysis

  • Kenichi Ishizu (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Tsutomu Hayashi (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Rei Ogawa (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Masashi Nishino (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Ryota Sakon (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Takeyuki Wada (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Sho Otsuki (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Yukinori Yamagata (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Hitoshi Katai (Department of Gastric Surgery, National Cancer Center Hospital) ;
  • Yoshiyuki Matsui (Cancer Medicine, Cooperative Graduate School, Jikei University Graduate School of Medicine) ;
  • Takaki Yoshikawa (Department of Gastric Surgery, National Cancer Center Hospital)
  • 투고 : 2024.01.16
  • 심사 : 2024.04.17
  • 발행 : 2024.07.01
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초록

Purpose: Despite annual endoscopy, patients with metachronous remnant gastric cancer (MRGC) following proximal gastrectomy (PG) are at times ineligible for endoscopic resection (ER). This study aimed to clarify the clinical risk factors for ER inapplicability. Materials and Methods: We reviewed the records of 203 patients who underwent PG for cT1 gastric cancer between 2006 and 2015. The remnant stomach was categorized as a pseudofornix, corpus, or antrum. Results: Thirty-two MRGCs were identified in the 29 patients. Twenty MRGCs were classified as ER (ER group, 62.5%), whereas 12 were not (non-ER group, 37.5%). MRGCs were located in the pseudo-fornix in 1, corpus in 5, and antrum in 14 in the ER group, and in the pseudofornix in 6, corpus in 4, and antrum in 2 in the non-ER group (P=0.019). Multivariate analysis revealed that the pseudo-fornix was an independent risk factor for non-ER (P=0.014). In the non-ER group, MRGCs at the pseudo-fornix (n=6) had more frequent undifferentiated-type histology (4/6 vs. 0/6), deeper (≥pT1b2; 6/6 vs. 2/6) and nodal metastasis (3/6 vs. 0/6) than non-pseudo-fornix lesions (n=6). We examined the visibility of the region developing MRGC on an annual follow-up endoscopy one year before MRGC detection. In seven lesions at the pseudofornix, visibility was only secured in two (28.6%) because of food residues. Of the 25 lesions in the non-pseudo-fornix, visibility was secured in 21 lesions (84%; P=0.010). Conclusions: Endoscopic visibility increases the chances of ER applicability. Special preparation is required to ensure the complete clearance of food residues in the pseudo-fornix.

키워드

과제정보

This study was supported by The Jikei University Research Fund for Graduate Students.

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