|
1
|
Huang Y, Ma L, Ren K, Gao Q, Zhu Z, Wang G, Cao B, He B. Current status of evaluation and treatment of early-stage remnant gastric cancer. Front Oncol 2024; 14:1457564. [PMID: 39605890 PMCID: PMC11598938 DOI: 10.3389/fonc.2024.1457564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 10/28/2024] [Indexed: 11/29/2024] Open
Abstract
Because of early diagnosis and improved prognosis, patients with gastric cancer are now surviving longer and remnant gastric cancer after gastrectomy is becoming more common. Remnant gastric cancer is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. In recent years, the development of endoscopic therapy has provided us with new therapeutic ideas. Although with some drawbacks, such as limited working space, gastric fibrosis and staples under the suture line, endoscopic management is still an effective treatment option with potential long-term survival advantage. For gastrectomy patients, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the early remnant gastric cancer. This review aims to provide an overview of remnant gastric cancer, especially focusing on its pathogenesis as well as new advances in the diagnosis and endoscopic treatment of early-stage remnant gastric cancer.
Collapse
Affiliation(s)
- Yinghui Huang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Ma
- Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Keyu Ren
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qun Gao
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenming Zhu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guangrong Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Cao
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baoguo He
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
|
2
|
Bringeland EA, Våge C, Ubøe AAS, Sandø AD, Mjønes P, Fossmark R. Epstein-Barr Virus and Clinico-Endoscopic Characteristics of Gastric Remnant Cancers Compared to Proximal Non-Remnant Cancers: A Population-Based Study. Cancers (Basel) 2024; 16:2000. [PMID: 38893119 PMCID: PMC11170983 DOI: 10.3390/cancers16112000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Epstein-Barr virus (EBV) is associated with 5-10% of gastric cancers and is recognized as a distinct molecular subtype. EBV positivity is particularly high in gastric remnant cancer (GRC), which may inform the mode of clinical presentation and findings at endoscopy. Most data are from the East, and the question remains how this applies to a Western cohort. We conducted a population-based study in Central Norway, 2001-2016. Patients with GRC (n = 78) and patients with non-GRC proximally located cancer and available tissue for EBV status (n = 116, control group) were identified from the Norwegian Cancer Registry. Relevant data were collected from the individual patient journals. EBV status was assessed using in situ hybridization. The median latency time from the distal gastrectomy to GRC was 37.6 (range 15.7-68.0) years. GRC more often presented with GI bleeding, 31.0% vs. 16.1%, p = 0.017, and at endoscopy more seldom with an ulcer, 19.7% vs. 38.2%, p = 0.012, or a tumour, 40.8% vs. 66.4%, p < 0.001. For GRC, 18.7% were EBV-positive compared to 6.0% among the controls, p = 0.006. EBV status was not associated with patient age, sex, or Lauren histological type. No difference in long-term survival rates between GRC and controls was found or between EBV-positive vs. -negative GRCs. In conclusion, a higher proportion of GRC cases, compared to controls, are EBV positive, indicating different causative factors. The mode of clinical presentation and findings at endoscopy were more subtle in the patients with GRC.
Collapse
Affiliation(s)
- Erling A. Bringeland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (C.V.); (A.A.S.U.); (A.D.S.); (P.M.); (R.F.)
- Department of Gastrointestinal Surgery, St. Olav’s Hospital, 7030 Trondheim, Norway
| | - Christina Våge
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (C.V.); (A.A.S.U.); (A.D.S.); (P.M.); (R.F.)
| | - Ann A. S. Ubøe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (C.V.); (A.A.S.U.); (A.D.S.); (P.M.); (R.F.)
| | - Alina D. Sandø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (C.V.); (A.A.S.U.); (A.D.S.); (P.M.); (R.F.)
- Department of Gastrointestinal Surgery, St. Olav’s Hospital, 7030 Trondheim, Norway
| | - Patricia Mjønes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (C.V.); (A.A.S.U.); (A.D.S.); (P.M.); (R.F.)
- Department of Pathology, St. Olav’s Hospital, 7030 Trondheim, Norway
| | - Reidar Fossmark
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (C.V.); (A.A.S.U.); (A.D.S.); (P.M.); (R.F.)
- Department of Gastroenterology, St. Olav’s Hospital, 7030 Trondheim, Norway
| |
Collapse
|
|
3
|
Ubøe AAS, Våge C, Mjønes P, Bringeland EA, Fossmark R. Gastric remnant cancer and long-term survival in Central Norway 2001 to 2016 - A population-based study. Surg Oncol 2023; 51:102008. [PMID: 37866308 DOI: 10.1016/j.suronc.2023.102008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Gastric remnant cancer (GRC) has been defined as a distinct clinical entity and is reported to account for 1-8% of all gastric cancers. We aimed to characterize GRC patients and assess survival in a Western population. METHODS Retrospective population-based cohort study including 1217 patients diagnosed with gastric adenocarcinoma in Central Norway 2001-2016. GRCs (n = 78) defined as adenocarcinomas arising in the residual stomach after distal gastrectomy were compared to non-GRC (n = 1139) and to proximal non-GRC (n = 595). RESULTS 78 (6.4 %) gastric cancers were GRC. The annual number and proportion of GRC declined during the study period (p = 0.003). Median latency from distal gastrectomy to GRC diagnosis was 37.6 years (15.7-68.0) and previous Billroth II reconstruction was most common (87.7%). Compared to controls, GRC patients were more frequently males (83.3%), diagnosed in earlier TNM stages and were older at diagnosis. A smaller proportion of GRC patients received perioperative or palliative chemotherapy, but the R0/R1resection rate of 41.0% was no different from non-GRC patients. Overall median survival for GRC patients irrespective of treatment was 7.0 months, which did not differ from non-GRCs or proximal non-GRC. In multivariate analyses TNM stage and age were independently associated with mortality, whereas GRC per se was not. CONCLUSIONS Numbers of GRCs declined during the study period, but the latency between distal gastrectomy and GRC diagnosis was long. GRC patients were more frequently male and older than other gastric cancer patients. GRC was not independently associated with survival after adjusting for TNM stage and tumor location.
Collapse
Affiliation(s)
- Ann Amelia Savage Ubøe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christina Våge
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Patricia Mjønes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, N-7006, Trondheim, Norway
| | - Erling A Bringeland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Gastrointestinal Surgery, St Olavś Hospital, Trondheim, Norway
| | - Reidar Fossmark
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Gastroenterology, St Olavś Hospital, Trondheim, Norway.
| |
Collapse
|
|
4
|
Wang SH, Zhang JC, Zhu L, Li H, Hu KW. Does gastric stump cancer really differ from primary proximal gastric cancer? A multicentre, propensity score matching-used, retrospective cohort study. World J Gastrointest Surg 2023; 15:2553-2563. [PMID: 38111756 PMCID: PMC10725541 DOI: 10.4240/wjgs.v15.i11.2553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/03/2023] [Accepted: 09/26/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Although the location of proximal cancer of the remnant stomach is the same as that of primary proximal cancer of the stomach, its clinical characteristics and prognosis are still controversial. AIM To evaluate the clinicopathological features and prognosis factors of gastric stump cancer (GSC) and primary proximal gastric cancer (PGC). METHODS From January, 2005 to December, 2016, 178 patients with GSC and 957 cases with PGC who received surgical treatment were enrolled. Patients in both groups underwent 1:1 propensity score matching analysis, and both clinical and pathological data were systematically collected for statistical purposes. Quality of life was evaluated by the C30 and STO22 scale between GSC-malignant (GSC following gastric cancer) and GSC-benign (GSC following benign lesions of the stomach). RESULTS One hundred and fifty-two pairs were successfully matched after propensity score matching analysis. Of the 15 demographic and pathological variables collected, the analysis further revealed that the number of lymph nodes and positive lymph nodes were different prognostic and clinicopathological factors between PGC and GSC. Univariate and multivariate analyses showed that gender, differentiation degree and tumor-node-metastasis stage were independent risk factors for patients with GSC. Gender, vascular invasion, differentiation degree, depth of infiltration, positive lymph nodes, and tumor-node-metastasis stage were independent risk factors for patients with PGC. The 5-year overall survival and cancer-specific survival of patients with GSC were significantly lower than those in the PGC group, the scores for overall quality of life in the GSC-malignant group were lower than the GSC-benign, and the differences were statistically significant. CONCLUSION The differences in clinicopathological characteristics between GSC and PGC were clarified, and PGC had a better prognosis than GSC.
Collapse
Affiliation(s)
- Shuan-Hu Wang
- Department of the General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Jing-Cheng Zhang
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich 80-819, Germany
| | - Liang Zhu
- Department of the General Surgery, Anhui Provincial Hospital, Hefei 230001, Anhui Province, China
| | - He Li
- Department of the Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China
| | - Kong-Wang Hu
- Department of the General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China
- Department of the General Surgery, The Fuyang Affiliated Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| |
Collapse
|
|
5
|
Shukla A, Kalayarasan R, Gnanasekaran S, Pottakkat B. Appraisal of gastric stump carcinoma and current state of affairs. World J Clin Cases 2023; 11:2864-2873. [PMID: 37215417 PMCID: PMC10198071 DOI: 10.12998/wjcc.v11.i13.2864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Gastric stump carcinoma, also known as remnant gastric carcinoma, is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition. Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma. The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases. The tumor location is predominantly at the anastomotic site towards the stomach. However, it can occur anywhere in the remnant stomach. The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer. Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes, thereby providing novel therapeutic targets. Also, reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis, staging, and treatment of these tumors. The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.
Collapse
Affiliation(s)
- Ankit Shukla
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| |
Collapse
|
|
6
|
Ramos MFKP, Pereira MA, Dias AR, Dantas ACB, Szor DJ, Ribeiro Jr U, Zilberstein B, Cecconello I. Remnant gastric cancer: An ordinary primary adenocarcinoma or a tumor with its own pattern? World J Gastrointest Surg 2021; 13:366-378. [PMID: 33968303 PMCID: PMC8069069 DOI: 10.4240/wjgs.v13.i4.366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/28/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Remnant gastric cancer (RGC) is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis. However, there little information available regarding RGCs and their prognostic factors and survival.
AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.
METHODS Patients who underwent curative resection for primary gastric cancer (GC) at our institute between 2009 and 2019 were retrospectively evaluated. All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study. Primary proximal GC (PGC) who underwent total gastrectomy was selected as the comparison group. Clinical and pathological data were collected from a prospective medical database.
RESULTS A total of 41 patients with RGC and 120 PGC were included. Older age (P = 0.001), lower body mass index (P = 0.006), hemoglobin level (P < 0.001), and number of resected lymph nodes resected (LN) (P < 0.001) were associated with the RGC group. Lauren type, pathological tumor-node-metastasis, and perioperative morbimortality were similar between RGC and PGC. There was no difference in disease-free survival (P = 0.592) and overall survival (P = 0.930) between groups. LN status was the only independent factor related to survival.
CONCLUSION RGC had similar clinicopathological characteristics to PGC. Despite the lower number of resected LN, RGC had a similar prognosis.
Collapse
Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Marina Alessandra Pereira
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Andre Roncon Dias
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Anna Carolina Batista Dantas
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Daniel Jose Szor
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Bruno Zilberstein
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo 01249000, Brazil
| |
Collapse
|
|
7
|
Ramos MFKP, Pereira MA, de Castria TB, Ribeiro RRE, Cardili L, de Mello ES, Zilberstein B, Ribeiro-Júnior U, Cecconello I. Remnant gastric cancer: a neglected group with high potential for immunotherapy. J Cancer Res Clin Oncol 2020; 146:3373-3383. [PMID: 32671505 DOI: 10.1007/s00432-020-03322-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The importance of targeted therapy and interest in the study of predictive markers in gastric cancer (GC) have increased in recent years with the use of anti-HER2 therapy and immunotherapy with anti-PD1/PD-L1 for microsatellite instability (MSI) and PD-L1 + tumors. However, the behavior of remnant GC (RGC) in this scenario is poorly reported. Thus, this study aims to evaluate the clinicopathological characteristics and prognosis of RGC and its association with the expression of current markers for targeted therapy. METHODS All RGC resections performed in a single center from 2009 to 2019 were retrospectively reviewed. As a comparison group, 53 primary proximal GC (PGC) who underwent total D2-gastrectomy were selected. HER2, MSI status and PD-L1 expression were analyzed by immunohistochemistry. Combined Positive Score (CPS) was used to determine PD-L1 positivity. RESULTS A total of 40 RGC were included. RGC patients were older (p = 0.001), had lower BMI (p = 0.001) and number of resected lymph nodes (p < 0.001) compared to the PGC. Regarding markers expression, MSI was higher in RGC than PGC (27.5% vs 9.4%, p = 0.022). The frequency of CPS-positive was 32.5% and 26.4% in RGC and PGC, respectively (p = 0.522). HER2 positivity was 17.5% and 22.6% for RGC and PGC, respectively (p = 0.543). In survival analysis, DFS was better for RGC CPS-positive than RGC CPS-negative (p = 0.039) patients. There was no difference in survival considering MSI status. CONCLUSION RGC had higher incidence of MSI than PGC, and CPS-positive RGC was associated with better survival. The immunological profile of RGC patients suggests that they would be good candidates for immunotherapy.
Collapse
Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil.
| | - Marina Alessandra Pereira
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Tiago Biachi de Castria
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Renan Ribeiro E Ribeiro
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Leonardo Cardili
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Evandro Sobroza de Mello
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Bruno Zilberstein
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Ulysses Ribeiro-Júnior
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| | - Ivan Cecconello
- Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil
| |
Collapse
|
|
8
|
Oh SE, An JY, Choi MG, Lee JH, Sohn TS, Bae JM. Comparisons of remnant primary, residual, and recurrent gastric cancer and applicability of the 8th AJCC TNM classification for remnant gastric cancer staging. Eur J Surg Oncol 2020; 46:2236-2242. [PMID: 32788098 DOI: 10.1016/j.ejso.2020.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Because there is no well-established postoperative staging system for patients with remnant gastric cancer (RGC), we compared the overall survival of patients categorized with the 8th AJCC TNM staging system. METHOD A total of 391 patients underwent surgery for RGC at our institution between 1996 and 2019. Among them, 201 patients received their first surgery at our institution and 190 received primary surgery elsewhere. We retrospectively reviewed their medical records and classified each according to Kaminishi's classification and the 8th AJCC TNM staging system for comparison and analysis. RESULTS All 201 patients who underwent their first operation at our institution for malignancy were classified as primary (n = 41, 20.4%), residual (n = 103, 51.2%), and recurrent (n = 57, 28.4%) RGC. The 5-year overall survival (OS) rates for the primary, residual, and recurrent RGC groups were 78.1%, 73.8% and 56.0%, respectively (p = 0.004). In a multivariate analysis, RGC classification was an independent prognostic factor along with the TNM staging system (p = 0.001). However, there was no significant difference in OS between the three groups of the same TNM stage. In addition, the OS of each stage related to primary cancer was not significantly different from the OS of RGC patients classified in TNM staging. CONCLUSION The RGC classification system we used may reflect the comprehensive aspects of previous disease states and predict the prognosis of patients with gastric cancer. In addition, the 8th AJCC TNM classification is a practical and applicable staging system for RGC.
Collapse
Affiliation(s)
- Sung Eun Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
|
9
|
Li Y, Zheng K. Surgical Outcomes of Gastric Remnant Cancer in Comparison with Primary Gastric Cancer: a Systematic Review and Meta-Analysis. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
|
10
|
Chen Q, Zhong Q, Zhou J, Qiu X, Dang X, Cai L, Su G, Xu D, Lin G, Guo K, Liu Z, Chen Q, Li P, Li T, Xie J, Lin S, Wang J, Lin J, Lu J, Cao L, Lin M, Zheng C, Lin W, He Q, Huang C. Conditional survival and recurrence of remnant gastric cancer after surgical resection: A multi-institutional study. Cancer Sci 2020; 111:502-512. [PMID: 31710406 PMCID: PMC7004538 DOI: 10.1111/cas.14231] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 12/13/2022] Open
Abstract
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 independently affected recurrence within 2 years after surgery (P < 0.05). A postoperative follow-up model was developed for RGC patients. In conclusion, patients with RGC usually have a high likelihood of death or recurrence within 3 years after radical surgery. We developed a postoperative follow-up model for RGC patients of different stages, which may affect the design of future clinical trials.
Collapse
|
|
11
|
Ramos MFKP, Pereira MCM, Oliveira YS, Pereira MA, Barchi LC, Dias AR, Zilberstein B, Ribeiro Junior U, Cecconello I. Surgical results of remnant gastric cancer treatment. Rev Col Bras Cir 2020; 47:e20202703. [PMID: 33263654 DOI: 10.1590/0100-6991e-20202703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. OBJECTIVE to evaluate surgical results and survival after CTG in patients with RGC. METHODS 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. RESULTS among the initial characteristics, age (68.0 vs. 60.5; p<0.001), hemoglobin values (10.9 vs. 12.3; p<0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. CONCLUSION despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered.
Collapse
Affiliation(s)
| | | | | | - Marina Alessandra Pereira
- - Instituto do Câncer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo - São Paulo - SP - Brasil
| | - Leandro Cardoso Barchi
- - Instituto do Câncer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo - São Paulo - SP - Brasil
| | - Andre Roncon Dias
- - Instituto do Câncer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo - São Paulo - SP - Brasil
| | - Bruno Zilberstein
- - Instituto do Câncer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo - São Paulo - SP - Brasil
| | - Ulysses Ribeiro Junior
- - Instituto do Câncer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo - São Paulo - SP - Brasil
| | - Ivan Cecconello
- - Instituto do Câncer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo - São Paulo - SP - Brasil
| |
Collapse
|
|
12
|
St-Louis E, Gowing SD, Mossallanejad P, Leimanis ML, Mueller C, Ferri LE. Outcomes after completion total gastrectomy for gastric remnant cancer: experience from a Canadian tertiary centre. Can J Surg 2019. [PMID: 30067186 DOI: 10.1503/cjs.008417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is controversy about the safety and outcomes of completion total gastrectomy (CTG) for gastric adenocarcinoma. We compared a cohort of patients who underwent CTG for gastric remnant cancer (GRC) after partial gastrectomy for benign disease with patients who underwent primary total gastrectomy (PTG) for sporadic gastric cancer. METHODS We retrospectively reviewed a single-institution, prospectively maintained clinical database of patients who had undergone gastrectomy from 2005 to 2016 for demographic, surgical, clinical and tumour pathology data, as well as postoperative, pathologic and oncologic outcomes including complications, length of stay, disease-free survival and overall survival. We used the χ2 and Wilcoxon rank-sum tests to compare groups and performed the Mantel-Cox log-rank test for Kaplan-Meier survival estimates. We compared the CTG group to all patients in the PTG group and to a 5:1 propensity-matched PTG cohort. RESULTS We analyzed data for 64 patients (9 CTG, 55 PTG). The groups were equivalent at baseline and had similar operative, perioperative treatment and pathologic characteristics. After propensity matching, the reoperation rate for complications was higher after CTG than PTG (22% v. 0%, p = 0.03), but there was no significant difference in the overall complication rate or length of stay. At 5 years, there was no difference in disease-free survival (28% v. 58%, p = 0.4) or overall survival (33% v. 44%, p = 0.7). CONCLUSION Our findings suggest that CTG for gastric adenocarcinoma can be undertaken safely a priori with no additional risk of recurrence or death compared to PTG for sporadic gastric cancer.
Collapse
Affiliation(s)
- Etienne St-Louis
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Stephen Donald Gowing
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Pedram Mossallanejad
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Mara Laura Leimanis
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Carmen Mueller
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Lorenzo Edwin Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| |
Collapse
|
|
13
|
Does remnant gastric cancer really differ from primary gastric cancer? A systematic review of the literature by the Task Force of Japanese Gastric Cancer Association. Gastric Cancer 2016; 19:339-349. [PMID: 26667370 DOI: 10.1007/s10120-015-0582-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
Remnant gastric cancer, most frequently defined as cancer detected in the remnant stomach after distal gastrectomy for benign disease and those cases after surgery of gastric cancer at least 5 years after the primary surgery, is often reported as a tumor with poor prognosis. The Task Force of Japanese Gastric Cancer Association for Research Promotion evaluated the clinical impact of remnant gastric cancer by systematically reviewing publications focusing on molecular carcinogenesis, lymph node status, patient survival, and surgical complications. A systematic literature search was performed using PubMed/MEDLINE with the keywords "remnant," "stomach," and "cancer," revealing 1154 relevant reports published up to the end of December 2014. The mean interval between the initial surgery and the diagnosis of remnant gastric cancer ranged from 10 to 30 years. The incidence of lymph node metastases at the splenic hilum for remnant gastric cancer is not significantly higher than that for primary proximal gastric cancer. Lymph node involvement in the jejunal mesentery is a phenomenon peculiar to remnant gastric cancer after Billroth II reconstruction. Prognosis and postoperative morbidity and mortality rates seem to be comparable to those for primary proximal gastric cancer. The crude 5-year mortality for remnant gastric cancer was 1.08 times higher than that for primary proximal gastric cancer, but this difference was not statistically significant. In conclusion, although no prospective cohort study has yet evaluated the clinical significance of remnant gastric cancer, our literature review suggests that remnant gastric cancer does not adversely affect patient prognosis and postoperative course.
Collapse
|
|
14
|
Ohira M, Toyokawa T, Sakurai K, Kubo N, Tanaka H, Muguruma K, Yashiro M, Onoda N, Hirakawa K. Current status in remnant gastric cancer after distal gastrectomy. World J Gastroenterol 2016; 22:2424-2433. [PMID: 26937131 PMCID: PMC4768189 DOI: 10.3748/wjg.v22.i8.2424] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.
Collapse
|
|
15
|
Păduraru DN, Nica A, Ion D, Handaric M, Andronic O. Considerations on risk factors correlated to the occurrence of gastric stump cancer. J Med Life 2016; 9:130-6. [PMID: 27453741 PMCID: PMC4863501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Gastric stump cancer (GSC) is the malignant tumor that develops in the gastric remnant after partial gastrectomy was performed both for benign and malignant lesions. This paper presents the results of the case studies from the scientific literature, which focused on GSC, and has been published in the last 10 years. The search was performed with the help of the specific tools offered by the international databases. The subject was approached because of the constant rising incidence of GSC in the past few years, now reaching values between 1% and 7%. The outcome report is consistent and similar to the period that ended approximately 25 years ago, when general surgeons dedicated a significant part of their activity to treating gastric ulcer. Statistics revealed that the main risk factors are the following: the type of reconstruction after distal gastrectomy (Billroth I or Billroth II), the presence of duodenogastric reflux, the time between gastric resections, and the moment of diagnosis of gastric stump cancer, the initial pathology for which partial gastrectomy was performed, gender, age, helicobacter pylori infection, Epstein Barr virus infection and the presence of vagotomy. All the authors have significantly contributed to the article and have been involved in the writing of the manuscript in draft and any revision stages, and have read and approved the final version.
Collapse
Affiliation(s)
- DN Păduraru
- III rd Department of General Surgery, University Emergency Hospital Bucharest, Romania,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A Nica
- Department of Anesthesiology, University Emergency Hospital Bucharest, Romania,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - D Ion
- III rd Department of General Surgery, University Emergency Hospital Bucharest, Romania,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M Handaric
- ”Gr. T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - O Andronic
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|