Endoscopic submucosal dissection for gastric tube cancer after esophagectomy

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• 作者：Satoru Nonaka ; Ichiro Oda ; Chiko Sato ; Seiichiro Abe ; Haruhisa Suzuki ; Shigetaka Yoshinaga ; Nobukazu Hokamura ; Hiroyasu Igaki ; Yuji Tachimori ; Hirokazu Taniguchi ; Ryoji Kushima ; Yutaka Saito
• 关键词：EGC ; early gastric cancer ; GTC ; gastric tube cancer ; ESD ; endoscopic submucosal dissection ; HM1 ; horizontal margin positive ; HMX ; horizontal margin inconclusive ; IT ; insulation-tipped ; LNM ; lymph node metastasis ; SM1 ; submucosal superficial cancer ; SM2 ; submucosal deep cancer
• 刊名：Gastrointestinal Endoscopy
• 出版年：February, 2014
• 年：2014
• 卷：79
• 期：2
• 页码：260-270
• 全文大小：1915 K

文摘

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Background

Recent improvements in the survival of patients after esophagectomy have led to an increasing occurrence of gastric tube cancer (GTC). Removal of the reconstructed gastric tube, however, can lead to high morbidity and mortality.

Objective

To assess the feasibility and effectiveness of endoscopic submucosal dissection (ESD) for GTC.

Design

Retrospective study.

Setting

National Cancer Center Hospital, Tokyo, Japan.

Patients

We investigated patients with GTC after esophagectomy undergoing ESD from 1998 to聽2011.

Intervention

ESD.

Main Outcome Measurements

Patient characteristics, endoscopic findings, technical results, histopathology including curability and Helicobacter pylori gastritis, and long-term outcomes.

Results

There were 51 consecutive patients with 79 lesions including 38 lesions (48%) meeting the absolute indication, 31 (39%) satisfying the expanded indications, and 10 (13%) falling outside such indications. The median procedure time was 90 minutes. There were 73 en bloc resections (92%), 59 en bloc resections with tumor-free margins (R0 resections, 75%), and 51 curative resections (65%) based on the Japanese Gastric Cancer Association criteria. Fifty patients (98%) were assessed as H pylori gastritis positive. Adverse events included 3 perforations (3.8%) during ESD and 2 delayed perforations (2.5%) without any emergency surgery and 3 delayed bleeding (3.8%). Local recurrence was detected in 4 patients (7.8%), and metachronous GTCs were identified in 18 patients (35%). Five patients (10%) died of GTC including 3 metachronous lesions. The 5-year overall survival rate was 68.4%, and the disease-specific survival rate was 86.7% with 100% for curative and 72.7% for non-curative patients during a median follow-up period of 3.8 years (range, 0-12.1 years).

Limitation

Single-center retrospective study.

Conclusions

ESD for GTC was feasible and effective for curative patients; however, long-term outcomes for non-curative patients were less satisfactory.