Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2021; 27(11): 1043-1054
Published online Mar 21, 2021. doi: 10.3748/wjg.v27.i11.1043
Efficacy and safety of endoscopic submucosal dissection for gastric tube cancer: A multicenter retrospective study
Takuya Satomi, Seiji Kawano, Tomoki Inaba, Masahiro Nakagawa, Hirokazu Mouri, Masao Yoshioka, Shoichi Tanaka, Tatsuya Toyokawa, Sayo Kobayashi, Takehiro Tanaka, Hiromitsu Kanzaki, Masaya Iwamuro, Yoshiro Kawahara, Hiroyuki Okada
Takuya Satomi, Seiji Kawano, Hiromitsu Kanzaki, Masaya Iwamuro, Hiroyuki Okada, 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
Yoshiro Kawahara, Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Okayama, Japan
Author contributions: Kawano S designed the study; Satomi T analyzed the data and wrote the manuscript; Okada H performed the quality assessment and critically revised the manuscript; Inaba T, Nakagawa M, Mouri H, Yoshioka M, Tanaka S, Toyokawa T, Kobayashi S, Tanaka T, Kanzaki H, Iwamuro M and Kawahara Y have read and agreed to the published version of the manuscript.
Institutional review board statement: This study was reviewed approved by the Ethics Committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital (approval No.1807-016).
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seiji Kawano, MD, PhD, Doctor, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayaka-shi, Okayama 700-8558, Okayama, Japan. skawano@mpd.biglobe.ne.jp
Received: November 7, 2020
Peer-review started: November 7, 2020
First decision: January 23, 2021
Revised: January 27, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: March 21, 2021
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.

Keywords: Endoscopic submucosal dissection, Gastric tube, Gastric cancer, Eso-phagectomy, Multicenter study, Retrospective study

Core Tip: Despite increasing occurrence of gastric tube cancer (GTC) after esophagectomy, there are few reports on the treatment results of endoscopic submucosal dissection (ESD) for GTC. This multicenter study showed that treatment results and complications of ESD for GTC were similar to those of standard ESD and there were not significantly difference between institutions except for procedure time. ESD for GTC after esophagectomy is a safe and effective treatment.