1
|
Agrawal R, Yang J, Ali S, Ghoulam E, Mutneja H, Bhurwal A, Boulay B, Villa EC. Safety and Efficacy of Endoscopic Submucosal Dissection in the Management of Gastric Tube Cancers After Esophagectomy: A Systematic Review. Cureus 2023; 15:e40526. [PMID: 37461759 PMCID: PMC10350321 DOI: 10.7759/cureus.40526] [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] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Esophagectomy is the proposed standard of care for resectable primary esophageal cancers and recurrent lesions in the reconstructed gastric tube (GT); however, it carries significant morbidity and mortality. Endoscopic submucosal dissection (ESD) has established its role in the management of primary esophageal cancers with growing evidence of its safety in resecting recurrent primary lesions in GT. Our study aims to evaluate the safety and efficacy of ESD in the management of recurrent, localized primary esophageal cancers in GT. We searched PubMed, CENTRAL, EMBASE, Scopus, and clinical trial registries from inception to March 2023 for articles evaluating the safety and efficacy of ESD in the management of recurrent cancerous lesions in GT. Our primary outcome was the en bloc resection rate. Secondary outcomes were curative resection rate, complete resection rate, intra-procedural complication rate, post-procedure complication rate, and five-year survival rate. Seven studies with a total of 165 patients undergoing 192 ESDs were included in the review. The pooled en bloc resection rate was 92.5% (95% CI: 87.7-95.6), which was reported in all seven studies. Pooled complete resection rate was 78.9% (95% CI: 64.5-88.5) per three studies, pooled curative resection rate was 73.9% (95% CI: 63.5-82.2) per four studies, and pooled intra-procedural complication rate was 10.2% (95% CI: 1.5-46.3), which was reported in four studies. Only three studies reported a five-year survival rate that was 65.5% (95% CI: 56.0-73.9). ESD is safe and efficacious in the management of GT cancer after esophagectomy.
Collapse
Affiliation(s)
- Rohit Agrawal
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - James Yang
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Saeed Ali
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Elie Ghoulam
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Hemant Mutneja
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Abhishek Bhurwal
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, USA
| | - Brian Boulay
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Edward C Villa
- Gastroenterology and Hepatology, NorthShore University Health System, Evanston, USA
| |
Collapse
|
2
|
Endoscopic Submucosal Dissection for Gastric Tube Carcinoma after Esophagectomy Contributes to Long-Term Outcomes. Can J Gastroenterol Hepatol 2022; 2022:1631415. [PMID: 35186806 PMCID: PMC8853775 DOI: 10.1155/2022/1631415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/29/2021] [Accepted: 01/17/2022] [Indexed: 12/26/2022] Open
Abstract
The incidence of gastric tube carcinoma (GTC) after esophagectomy for esophageal carcinoma has increased in recent years. Surgical removal of the reconstructed gastric tube is associated with high mortality, and endoscopic submucosal dissection (ESD) is a promising alternative. There are limited reports of ESD for GTC. This study investigated the efficacy and safety of ESD in GTC. This single-center retrospective study examined patients who underwent ESD for GTC after esophagectomy at our institution between 2003 and 2018. The curability of GTC with ESD was evaluated histologically according to the Japanese Gastric Cancer Treatment Guidelines. Patient characteristics and procedural and long-term outcomes were analyzed. Overall, 31 patients (29 men and 2 women; median age, 73 years) with 45 GTC lesions underwent ESD. The mean period between primary esophagectomy and the diagnosis of GTC was 10.6 years. Bleeding during ESD was noted in two patients (6.5%). No other adverse or fatal events such as perforation were noted. Complete resection and curative resection were documented in 80.6% and 48.4% of cases, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC, and fourteen patients died of other diseases, including primary carcinoma in five cases. ESD was safe and provided good long-term outcomes in patients with GTC. Regular long-term gastroscopy is required for the early detection of GTC. Patients with GTC after esophagectomy for esophageal carcinoma have a high risk of other primary carcinomas or comorbidities after ESD.
Collapse
|
3
|
Sakai A, Okumura T, Miwa T, Watanabe T, Numata Y, Araki M, Ito A, Kanaya E, Sakurai T, Fukazawa M, Hoshino Y, Tohmatsu Y, Tokai R, Baba H, Hirano K, Igarashi T, Hashimoto I, Shibuya K, Hojo S, Matsui K, Yoshioka I, Fujii T. Distal partial gastrectomy for gastric tube cancer with intraoperative blood flow evaluation using indocyanine green fluorescence. J Surg Case Rep 2021; 2021:rjab574. [PMID: 34987762 PMCID: PMC8711863 DOI: 10.1093/jscr/rjab574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
With recent advances in the treatment of esophageal cancer and long-term survival after esophagectomy, the number of gastric tube cancer (GTC) has been increasing. Total gastric tube resection with lymph node dissection is considered to be a radical treatment, but it causes high post-operative morbidity and mortality. We report an elderly patient with co-morbidities who developed pyloric obstruction due to GTC after esophagectomy with retrosternal reconstruction. The patient was treated using distal partial gastric tube resection (PGTR) and Roux-en-Y reconstruction with preservation of the right gastroepiploic artery and right gastric artery. Intraoperative blood flow visualization using indocyanine green (ICG) fluorescence demonstrated an irregular demarcation line at the distal side of the preserved gastric tube, indicating a safe surgical margin to completely remove the ischemic area. PGTR with intraoperative ICG evaluation of blood supply in the preserved gastric tube is a safe and less-invasive surgical option in patients with poor physiological condition.
Collapse
Affiliation(s)
- Ayano Sakai
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Tomoyuki Okumura
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Takeshi Miwa
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Toru Watanabe
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yoshihisa Numata
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Misato Araki
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Ayaka Ito
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Emi Kanaya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Taro Sakurai
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Mina Fukazawa
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yui Hoshino
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yuuko Tohmatsu
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Ryutaro Tokai
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hayato Baba
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Katsuhisa Hirano
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Takamichi Igarashi
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Isaya Hashimoto
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shozo Hojo
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Koshi Matsui
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Isaku Yoshioka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| |
Collapse
|
4
|
Ludwig K, Enz N, Kreutzer H, Pickartz T. Metachronous carcinoma of the gastric tube following tumour-associated oesophagectomy. Langenbecks Arch Surg 2021; 406:2263-2272. [PMID: 34491431 DOI: 10.1007/s00423-021-02316-4] [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: 03/15/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The prognosis of oesophageal carcinoma has improved during the last years. Thereby, the increasing survival has led to increasing occurrence of secondary gastric tube carcinoma (gastric conduit cancer, GTC) following oesophageal tumour resection. MATERIAL AND PATIENTS A literature review (EMBASE, PubMed), spanning the years 2000 to 2020, identified 342 patients worldwide with a GTC following tumour-related oesophagectomy, of which 306 patients could be included for further analysis. RESULTS The median age of 306 patients with GTC was 66.4 (39-80) years. 91.2% of patients (n = 279) were male. The median interval between oesophagectomy and GTC was 60.3 (4-236) months. 73.8% of patients (n = 226) were diagnosed as early cancer (EGC, T1) and 26.2% as advanced carcinoma (AGC, > T2; n = 80). Primary oesophagectomy was performed in 97.4% of patients (N = 298) for squamous cell carcinoma. AEG I carcinoma was present in only 5 patients (1.6%). In contrast, 99% (n = 303) of the GTC were found to be adenocarcinomas. One hundred eighty patients (58.8%) could be treated by endoscopic resection (ER). R0 resection was achieved in 82.8% (n = 149). The complication rate was 13.3% (n = 24) and the 30-day mortality 1.1% (n = 2) for ER. Eighty-three patients (27.1%) were treated surgically. These included 13 wedge resections, 25 partial resections and 45 total gastric graft resections with predominantly colon interposition. The R0 rate was 98.8% (n = 82). The postoperative morbidity was 24.1% (n = 20); the 90-day mortality was 6% (n = 5). In 43 patients (14%), palliative chemotherapy or radiotherapy or best supportive care took place. GTC diagnosed early in the EGC stage can be safely managed with ER. In cases of advanced GTC, surgical resection can be a potentially curative approach. Survival times of up to 120 months have been described after intervention for GTC.
Collapse
Affiliation(s)
- Kaja Ludwig
- Department of General and Visceral Surgery, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany.
| | - Njanja Enz
- Department of General and Visceral Surgery, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany
| | - Hans Kreutzer
- Institute for Pathology, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany
| | - Tilman Pickartz
- Department for Internal Medicine A, F.-Sauerbruchstr, University Hospital Greifswald, 17475, Greifswald, Germany
| |
Collapse
|
5
|
Satomi T, Kawano S, Inaba T, Nakagawa M, Mouri H, Yoshioka M, Tanaka S, Toyokawa T, Kobayashi S, Tanaka T, Kanzaki H, Iwamuro M, Kawahara Y, Okada H. Efficacy and safety of endoscopic submucosal dissection for gastric tube cancer: A multicenter retrospective study. World J Gastroenterol 2021; 27:1043-1054. [PMID: 33776371 PMCID: PMC7985736 DOI: 10.3748/wjg.v27.i11.1043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/27/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent improvements in the prognosis of patients with esophageal cancer have led to the increased occurrence of gastric tube cancer (GTC) in the reconstructed gastric tube. However, there are few reports on the treatment results of endoscopic submucosal dissection (ESD) for GTC.
AIM To evaluate the efficacy and safety of ESD for GTC after esophagectomy in a multicenter trial.
METHODS We retrospectively investigated 48 GTC lesions in 38 consecutive patients with GTC in the reconstructed gastric tube after esophagectomy who had undergone ESD between January 2005 and December 2019 at 8 institutions participating in the Okayama Gut Study group. The clinical indications of ESD for early gastric cancer were similarly applied for GTC after esophagectomy. ESD specimens were evaluated in 2-mm slices according to the Japanese Classification of Gastric Carcinoma with curability assessments divided into curative and non-curative resection based on the Gastric Cancer Treatment Guidelines. Patient characteristics, treatment results, clinical course, and treatment outcomes were analyzed.
RESULTS The median age of patients was 71.5 years (range, 57-84years), and there were 34 men and 4 women. The median observation period after ESD was 884 d (range, 8-4040 d). The median procedure time was 81 min (range, 29-334 min), the en bloc resection rate was 91.7% (44/48), and the curative resection rate was 79% (38/48). Complications during ESD were seen in 4% (2/48) of case, and those after ESD were seen in 10% (5/48) of case. The survival rate at 5 years was 59.5%. During the observation period after ESD, 10 patients died of other diseases. Although there were differences in the procedure time between institutions, a multivariate analysis showed that tumor size was the only factor associated with prolonged procedure time.
CONCLUSION ESD for GTC after esophagectomy was shown to be safe and effective.
Collapse
Affiliation(s)
- Takuya Satomi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 730-8518, Hiroshima, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki 710-8602, Okayama, Japan
| | - Masao Yoshioka
- Department of Gastroenterology and Hepatology, Okayama Saiseikai General Hospital, Okayama 700-8511, Okayama, Japan
| | - Shoichi Tanaka
- Department of Gastroenterology, National Hospital Organization Iwakuni Clinical Center, Iwakuni 740-8510, Yamaguchi, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama 720-8521, Hiroshima, Japan
| | - Sayo Kobayashi
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama 721-8511, Hiroshima, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Okayama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
| |
Collapse
|
6
|
Yura M, Koyanagi K, Adachi K, Hara A, Hayashi K, Tajima Y, Kaneko Y, Fujisaki H, Hirata A, Takano K, Hongo K, Yo K, Yoneyama K, Dehari R, Nakagawa M. Distal gastric tube resection with vascular preservation for gastric tube cancer: A case report and review of literature. World J Gastrointest Surg 2020; 12:397-406. [PMID: 33024514 PMCID: PMC7520569 DOI: 10.4240/wjgs.v12.i9.397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved, but the prevalence of gastric tube cancer (GTC) has also increased. Total resection of the gastric tube with lymph node dissection is considered a radical treatment, but GTC surgery is more invasive and involves a higher risk of severe complications or death, particularly in elderly patients. CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y (R-Y) reconstruction. The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring. Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive, was undifferentiated type, surrounded the pyloric ring, and had invaded the duodenum. Resection of distal gastric tube with R-Y reconstruction was safely performed, with preservation of the right gastroepiploic artery (RGEA) and right gastric artery (RGA). CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.
Collapse
Affiliation(s)
- Masahiro Yura
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Japan
| | - Kiyohiko Adachi
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Asuka Hara
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Keita Hayashi
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yuki Tajima
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yasushi Kaneko
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Hiroto Fujisaki
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kumiko Hongo
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kikuo Yo
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kimiyasu Yoneyama
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Reiko Dehari
- Department of Surgical Pathology, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Motohito Nakagawa
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| |
Collapse
|
7
|
Gentile D, Riva P, Da Roit A, Basato S, Marano S, Castoro C. Gastric tube cancer after esophagectomy for cancer: a systematic review. Dis Esophagus 2019; 32:5492605. [PMID: 31111880 DOI: 10.1093/dote/doz049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4-236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.
Collapse
Affiliation(s)
- Damiano Gentile
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Pietro Riva
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Anna Da Roit
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Silvia Basato
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Salvatore Marano
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Carlo Castoro
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| |
Collapse
|
8
|
Barakat M, Seif M, Abdelfatah MM, Ofosu A, Carr-Locke DL, Othman MO. Endoscopic submucosal dissection for early neoplastic lesions in the surgically altered stomach: a systematic review and meta-analysis. Surg Endosc 2019; 33:2381-2395. [PMID: 30963259 DOI: 10.1007/s00464-019-06778-y] [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: 10/15/2018] [Accepted: 04/04/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND AIM Endoscopic submucosal dissection (ESD) for early gastric cancer is highly effective and well established. Performing ESD in the surgically altered stomach (SAS) is challenging. The aim of this meta-analysis is to assess the safety and efficacy of ESD for patients with early neoplastic lesions occurring in the SAS with a subgroup analysis of lesions occurring on the suture line compared to non-suture line lesions and outcomes in the remnant stomach compared to the gastric tube. METHODS We performed a literature search of the PubMed, Embase, and CINAHL electronic databases from January 2000 to November 2017 for articles reporting the safety and efficacy of ESD in the surgically altered stomach. SAS was defined as the remnant stomach following gastrectomy and gastric tube following esophagectomy. Meta-analysis was performed using Review Manager version 5.3 software. RESULTS A total of 21 articles, with 903 lesions occurring in the remnant stomach or gastric tube, were included in this study. There was no significant difference between en bloc (RR 0.99, 95% CI 0.91-1.08), curative resection (RR 1.03, 95% CI 0.84-1.26), or bleeding rates (RR 1.40, 95% CI 0.18-10.72) between lesions in the remnant stomach and gastric tube. However, perforation was significantly higher in the gastric tube (RR 5.19, 95% 1.27-21.25). Suture line lesions had a significantly higher risk of perforation (RR 4.55, 95% CI 2.13-9.74). CONCLUSION ESD for early neoplastic lesions occurring in the SAS is a safe and efficacious with similar en bloc and curative resection rates compared to the anatomically normal stomach. ESD for lesions on the suture line or in the gastric tube is associated with an increased risk of perforation which can be managed endoscopically.
Collapse
Affiliation(s)
- Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, 121 De Kalb Ave, Brooklyn, NY, 11201, USA.
| | | | | | - Andrew Ofosu
- Division of Gastroenterology, The Brooklyn Hospital, Brooklyn, NY, USA
| | | | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
9
|
Sakaki A, Kanamori J, Sato A, Okada N, Ishiyama K, Kurita D, Oguma J, Daiko H. Case report: Gastric tube cancer after esophagectomy-Retrograde perfusion after proximal resection of right gastroepiploic artery. Int J Surg Case Rep 2019; 59:97-100. [PMID: 31125790 PMCID: PMC6531823 DOI: 10.1016/j.ijscr.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/09/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION We report a case of a 57-year-old patient with gastric tube cancer after subtotal esophagectomy and retrosternal gastric pull up. CASE PRESENTATION The patient developed gastric cancer 4 years after undergoing treatment for esophageal squamous cell cancer; the treatments included thoracoscopic subtotal esophagectomy, gastric pull-up reconstruction via a retrosternal route in salvage setting following definitive chemoradiation. Because the gastric tube cancer was located around the pylorus, transabdominal partial resection, which is much less invasive than total resection via sternotomy, was performed. During surgery, retrograde pulsation of the proximally resected right gastroepiploic artery was observed. Owing to an ample blood supply to the oral remnant of the gastric tube, vascular reconstruction of the right gastroepiploic artery was omitted. The postoperative recovery was eventless. DISCUSSION The right gastroepiploic artery is considered essential for blood supply to the gastric tube. However, there was no sign of ischemia after proximal resection of this artery, which suggests the vasculature was altered after gastric tube construction. CONCLUSION This case shows that partial distal resection of the gastric tube can be performed safely without vascular reconstruction of the right gastroepiploic artery. Favorable long-term results after gastric tube reconstruction support the possibility of bilateral blood supply to the gastroepiploic arcade.
Collapse
Affiliation(s)
- Akio Sakaki
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Jun Kanamori
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Ataru Sato
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Naoya Okada
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Koshiro Ishiyama
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Daisuke Kurita
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Junya Oguma
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan.
| |
Collapse
|
10
|
Clinical Outcomes and Adverse Events of Endoscopic Submucosal Dissection for Gastric Tube Cancer after Esophagectomy. Gastroenterol Res Pract 2019; 2019:2836860. [PMID: 30944559 PMCID: PMC6421774 DOI: 10.1155/2019/2836860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background and Aim The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric tube cancer (GTC) after esophagectomy remain unclear. The aim of this study was to evaluate the clinical outcomes and safety of ESD for GTC. Patients and Methods Twenty GTC lesions in 18 consecutive patients who underwent ESD between February 2008 and June 2018 were included in this retrospective study. The endpoints were the treatment outcomes of ESD (i.e., en bloc resection rate, complete en bloc resection rate, and curative resection rate), the adverse events following ESD, and the long-term outcomes. Results The en bloc resection rate was 100%, while the complete en bloc resection rate and curative resection rate were 80% each. Adverse events were observed in 16.7% (3/18) of patients: one postoperative bleeding, 1 intraoperative perforation that required emergency surgery, and 1 pyothorax that required chest drainage. The 1-, 3-, and 5-year overall survival rates were 100%, 70.9%, and 70.9%, respectively. Although local recurrence was detected in 1 case of noncurative resection, no GTC- or ESD-related deaths were observed. Conclusion ESD for GTC was feasible and acceptable to enable en bloc resection and to prevent cancer death. However, ESD for GTC should be performed more carefully than common gastric ESD because serious adverse events specific to the gastric tube may occur.
Collapse
|