Can we apply the same indications of ESD for primary gastric cancer to remnant gastric cancer?
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Can we apply the same indications of ESD for primary gastric cancer to remnant gastric cancer?

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Can we apply the same indications of ESD for primary gastric cancer to remnant gastric cancer? Presentation Transcript

  • 1. Can we apply the same indications ofESD for primary gastric cancer toremnant gastric cancer?Saeed Alshomimi, Yoon Young Choi, In Gyu Kwon, Woo Jin Hyung,Sung Hoon NohDepartment of Surgery, Yonsei University Health system
  • 2. Cancer in the remnant stomach1~7% of all gastric cancerRisk of cancer : 4~7 fold after 20 yearsrisk increasing 28% by every 5 yearsIntroduction
  • 3. IntroductionPartial Gastrectomy↓ Blood supplyDenervationDuodenalrefluxHormonalchangeDamage of gastric mucosaCell proliferation↑↑ pHin stomachNitratereducingbacteria↑Nitrosamine↑RGC
  • 4. IntroductionCancer in Remnant StomachRemnant Gastric Cancer(cancer after cancer)Gastric Stump Cancer( Cancer after Benign )1- Curative gastrectomy2- interval of 12 months3- pathologically confirmedadenocarcinoma in the remnant stomachIncidence
  • 5. IntroductionTreatment?Complete resection of carcinoma withradical LN dissectionDifficult to do because of :postoperative adhesionanatomical deformation
  • 6. Role of EMR & ESD for primary gastric cancerIntroduction
  • 7. Role of EMR & ESD for RGC?Has yet been decided because ofpossible effects of previous cancerlack of sufficient dataHowever,RGC will increaseearly detection would be possibleNeed the indication of ESD for RGCIntroduction
  • 8. Materialsand Methods105 patients underwent CTG for RGC(from January 1998 to December 2010)Exclude gastric stump cancer(cancer after benign)Adopting same indication of ESD for primarygastric cancer
  • 9. CTG for RGC( n = 105 )Advancedn= 64 (61%)Early RGCn=41 (39%)Contraindicationsfor ESDN = 24ExpandedIndicationsfor ESDN = 11AbsoluteIndicationsfor ESDN = 6ESD for RGC( n = 5 )Results
  • 10. T-stage Number of patients(LN+ patients/total patients)LN (positive LN/retrieved LN)Early RGC(n=41)m 0/25 0/224sm 1*/16 1/120Total 1/41 1/344ResultsCTG for RGC( n = 105 )Early RGCn=41(39%)ESD for RGC( n = 5 )
  • 11. Numberof caseAge Sex T-stage Histological typePresenceof UlcerSize Location Lymph Nodepositive LN/retrieved LNDuration ofFollow up(months)1 45 M m Diff - ≤20mm NAS 0/6 145AI forESD2 71 M m Diff - ≤20mm NAS 0/11 793 66 M m Diff - ≤20mm Anastomotic site 0/19 814 73 M m Diff - ≤20mm Anastomotic site 0/13 245 76 M m Diff - ≤20mm Anastomotic site 0/8 306 66 M m Diff - ≤20mm NAS 0/1 247 70 M m Undiff - ≤20mm Anastomosis site 0/10 98*EI forESD8 52 M m Undiff - ≤20mm NAS 0/0 739 40 M m Undiff - ≤20mm NAS 0/0 1810 68 M m Diff - ≤30mm Anastomotic site 0/52 7511 47 F m Undiff - ≤20mm NAS 0/2 1812 74 M m Undiff - ≤20mm Anastomosis site 0/5 4113 63 M m Undiff - ≤20mm Anastomosis site 0/11 3514 33 F m Undiff - ≤20mm NAS 0/15 4415 59 F m Undiff - ≤20mm NAS 0/8 2416 43 F m Undiff - ≤20mm NAS 0/3 1817 66 F Sm1 Diff ≤30mm NAS 0/1 30ResultsNometastaticLN
  • 12. CaseAge3 SexReconstruction typeLN dissection Stage Interval to ESD(months) LocationDuration of Follow up(months)1 75 M DG with BII D1 + T1N0 13 NAS 522 77 M DG with BII D1 + T1N0 87 NAS 2113 64 M DG with BII D1 T1N0 32 NAS 3524 55 M DG with BI D1 + T3N3 48 NAS 155 66 M DG with BI D1 T1N0 25 NAS 42ResultsPatients who underwent endoscopic submucosal dissection for remnant gastric cancer
  • 13. CTG (n=17, range) ESD (n=5, range)OP time (minutes) 216 (125~300) 70 (30 ~ 140)Hospital stay (days) 8 (6~83) 2 (2~9)ComplicationsMinorAtelectasis : 3 (1 NAS, 2 anastomosis)Transfusion : 1 (NAS)1Intra-abdominal abscess : 1 (NAS)MajorIntra-abdominal abscess with pleural effusion: 1 (NAS)1Re-operation with intensive care unit care : 1(NAS)OthersCombined splenectomy due to injuryMinorFree air : 1OthersIn procedure bleeding : 2Need clipping : 1Need coagulation : 1Results
  • 14. The largest data but still insufficientSame indication would be possibleNeed more evidence from multinational &multicenter reviewDiscussion
  • 15. Thanks for yourattention!