Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.416
Peer-review started: January 23, 2019
First decision: March 14, 2019
Revised: April 1, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: May 15, 2019
Proximal gastrectomy (PG) is performed widely as a function-preserving operation for early gastric cancer located in the upper third of the stomach and is an important function-preserving approach for esophagogastric junction (EGJ) adenocarcinoma. The incidence of gastric stump cancer (GSC) after PG is increasing. However, little is known about the GSC following PG because very few studies have been conducted on the disease. To our knowledge, there are only few studies have been published on GSC following PG.
The clinicopathological characteristics, treatment, and prognosis of GSC after distal gastrectomy have been well investigated; however, there is limited information on GSC after PG. As such, we conducted a single-center retrospective study to understand the associated clinicopathological features, surgical results and long-term outcomes of GSC following PG.
The aim of this study is to clarify clinicopathologic features, perioperative complications, and long-term survival rates after resection of GSC following PG. We revealed characteristics of GSC following PG in detail with the largest number of patients to date.
This is a retrospective study. Thirty-five patients who had undergone resection of the gastric stump for GSC following PG at Cancer Hospital of the Chinese Academy of Medical Sciences were eligible for inclusion in the study. Medical records were reviewed with regard to preoperative medical conditions, perioperative complications, histopathological results and follow-up data. Cumulative survival rates were obtained using the Kaplan–Meier method and compared using the log-rank test to evaluate statistically significant differences. Cox proportional hazards regression analysis was used to evaluate factors affecting overall survival (OS).
This study reveals the characteristics of GSC following PG for adenocarcinoma of the EGJ and suggests that a surgical approach can lead to a satisfactory outcome. GSC is more likely to be diagnosed at an advanced stage, and thus, endoscopic follow-up of the gastric stump should be conducted to detect GSC at an early stage. Further larger-scale studies are necessary to clarify the characteristics of the disease.
We revealed the characteristics of GSC following PG for adenocarcinoma of the EGJ and suggests that a surgical approach can lead to a satisfactory outcome. GSC is more likely to be diagnosed at an advanced stage, and thus, endoscopic follow-up of the gastric stump should be conducted to detect GSC at an early stage. The incidence of GSC after PG is increasing. Surgical approach can lead to a satisfactory outcome. This is the first study investigating GSC following PG for EGJ adenocarcinoma. GSC following PG should be compared with initial distal gastric cancer. We defined GSC according to the Japanese Classification and Treatment Guidelines for Gastric Cancer (14th edition). Our results suggest that surgical approaches can achieve satisfactory outcomes in GSC following PG, similar to those in patients with typical gastric cancer. There are only few studies have been published on GSC following PG. This study reveals the characteristics of GSC following PG for adenocarcinoma of the EGJ. Endoscopic follow-up of the gastric stump should be conducted to detect GSC at an early stage. Surgical approach should be performed for patients with GSC following PG.
The factor associated with OS based on multivariate analysis was advanced T stage and GSC is more likely to be diagnosed at an advanced stage. Thus, endoscopic follow-up of the gastric stump should be conducted to detect GSC at an early stage.