Time Interval After Various Types of Gastrectomy Until Metachronous Multiple Gastric Cancer: Analysis of Data From A Nationwide Japanese Survey

Abstract Background The time interval between initial partial gastrectomy and diagnosis of cancer in the remnant stomach reportedly differs according to the reconstruction procedure used in the initial gastrectomy. However, factors correlated with the time interval from the initial surgery for gastric cancer to the detection of metachronous multiple gastric cancer (MMGC) remain unclear. This study was performed to evaluate the association between the type of initial gastrectomy or reconstruction procedure and the time interval from initial gastrectomy to detection of MMGC as well as the association between the type of initial gastrectomy and the procedure performed for MMGC. Methods A questionnaire survey on remnant stomach cancer was conducted by the Japanese Society for Gastro-Surgical Pathophysiology in 2018. Participating facilities were asked to indicate the number of patients who underwent surgery for MMGC between 2003 and 2017, in accordance with the time interval from the initial gastrectomy until treatment for MMGC by type of initial gastrectomy or reconstruction procedure. The number of patients who underwent each treatment procedure (completion total gastrectomy or partial gastrectomy) was also collected. Results Analyses were performed using data from 45 facilities. Gastrectomy for MMGC was performed in 1,234 patients during the period. Billroth-II and Roux-en Y accounted for 22.3% (103/462) and 1.3% (6/462), respectively, of patients who underwent surgery for MMGC ≥ 10 years from initial DG, while these patients accounted for 8.0% (23/286) and 21.7% (65/286), respectively, of patients who underwent surgery for MMGC within 5 years after initial DG. Likewise, the proportion of each reconstruction procedure differed by the time interval from initial proximal gastrectomy to treatment for MMGC. In terms of the treatments performed for MMGC, the proportion of patients who underwent partial gastrectomy increased in accordance with the size of the remnant stomach after the initial gastrectomy. Conclusions The types of gastrectomy or reconstruction procedures for initial gastrectomy differed significantly by time interval between the initial gastrectomy and treatment for MMGC, and their time trends were assumed to be a major cause of the differences. The proportion of patients who underwent completion total gastrectomy deceased as the size of the remnant stomach increased.

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The incidences of metachronous multiple gastric cancer after various types of gastrectomy: analysis of data from a nationwide Japanese survey

Gastric Cancer ◽

10.1007/s10120-020-01104-1 ◽

2020 ◽

Vol 24 (1) ◽

pp. 22-30

Author(s):

Shinichi Kinami ◽

Masaki Aizawa ◽

Hiroharu Yamashita ◽

Koshi Kumagai ◽

Satoshi Kamiya ◽

...

Keyword(s):

Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Proximal Gastrectomy ◽

Remnant Stomach ◽

Submucosal Dissection ◽

Initial Surgery ◽

The Status ◽

Multiple Gastric Cancer ◽

Segmental Gastrectomy ◽

And Function

Abstract Background The incidence of metachronous multiple gastric cancer (MMGC) after gastrectomy remains unclear. This study evaluated the incidences of MMGC according to specific gastrectomy types, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy (PG), and function-preserving gastrectomy (FPG), which was categorized as segmental gastrectomy and local resection. Methods We conducted a questionnaire survey of the Japanese Society for Gastro-Surgical Pathophysiology members, who were asked to report their institutional numbers of radical gastrectomy cases for cancer between 2003 and 2012. The cases were categorized according to whether the remnant stomach’s status was followed for > 5 years, confirmation of MMGC, time to diagnosis, and treatment for MMGC. We calculated the “precise incidence” of MMGC by dividing the number of MMGC cases by the number of cases in which the status of remnant stomach was followed up for > 5 years. Results The responses identified 33,731 cases of gastrectomy. The precise incidences of MMGC were 2.35% after distal gastrectomy (DG), 3.01% after PPG, 6.28% after PG (p < 0.001), and 8.21% after FPG (p < 0.001). A substantial proportion of MMGCs (36.4%) was found at 5 years after the initial surgery. The rates of MMGC treatment using endoscopic submucosal dissection were 31% after DG, 28.6% after PPG, 50.8% after PG (p < 0.001), and 67.9% after FPG (p < 0.001). Conclusions The incidence of MMGC was 2.4% after DG, and higher incidences were observed for larger stomach remnants. However, the proportion of cases in which MMGC could be treated using endoscopic submucosal dissection was significantly higher after PG and FPG than after DG.

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Reconstruction Methods and Complications in Proximal Gastrectomy for Gastric Cancer, and a Comparison with Total Gastrectomy

The Kurume Medical Journal ◽

10.2739/kurumemedj.ms64003 ◽

2014 ◽

Vol 61 (1.2) ◽

pp. 23-29 ◽

Cited By ~ 5

Author(s):

TARO ISOBE ◽

KOUSUKE HASHIMOTO ◽

JUNYA KIZAKI ◽

SATORU MATONO ◽

NAOTAKA MURAKAMI ◽

...

Keyword(s):

Gastric Cancer ◽

Total Gastrectomy ◽

Proximal Gastrectomy ◽

Reconstruction Methods

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Three cases of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy for gastric cancer in remnant stomach

World Journal of Surgical Oncology ◽

10.1186/1477-7819-12-342 ◽

2014 ◽

Vol 12 (1) ◽

pp. 342 ◽

Cited By ~ 7

Author(s):

Yu Pan ◽

Yi-Ping Mou ◽

Ke Chen ◽

Xiao-Wu Xu ◽

Jia-Qin Cai ◽

...

Keyword(s):

Gastric Cancer ◽

Total Gastrectomy ◽

Remnant Stomach ◽

Laparoscopic Total Gastrectomy ◽

Intracorporeal Esophagojejunostomy

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Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary

Langenbeck s Archives of Surgery ◽

10.1007/s00423-016-1422-3 ◽

2016 ◽

Vol 401 (5) ◽

pp. 687-697 ◽

Cited By ~ 15

Author(s):

Pavan Sugoor ◽

Sanket Shah ◽

Rohit Dusane ◽

Ashwin Desouza ◽

Mahesh Goel ◽

...

Keyword(s):

Gastric Cancer ◽

Total Gastrectomy ◽

Proximal Gastrectomy

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Short-term and long-term comparisons of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy by the double-flap technique and laparoscopy-assisted total gastrectomy for proximal gastric cancer

PLoS ONE ◽

10.1371/journal.pone.0242223 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242223

Author(s):

Tomoko Tsumura ◽

Shinji Kuroda ◽

Masahiko Nishizaki ◽

Satoru Kikuchi ◽

Yoshihiko Kakiuchi ◽

...

Keyword(s):

Gastric Cancer ◽

Nutritional Status ◽

Total Gastrectomy ◽

Proximal Gastrectomy ◽

Proximal Gastric Cancer ◽

Short Term ◽

Flap Technique ◽

Significant Difference

Background Although proximal gastrectomy (PG) is a recognized surgical procedure for early proximal gastric cancer, total gastrectomy (TG) is sometimes selected due to concern about severe gastroesophageal reflux. Esophagogastrostomy by the double-flap technique (DFT) is an anti-reflux reconstruction after PG, and its short-term effectiveness has been reported. However, little is known about the long-term effects on nutritional status and quality of life (QOL). Methods Gastric cancer patients who underwent laparoscopy-assisted PG (LAPG) with DFT or laparoscopy-assisted TG (LATG) between April 2011 and March 2014 were retrospectively analyzed. Body weight (BW), body mass index (BMI), and prognostic nutritional index (PNI) were reviewed to assess nutritional status, and the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 was used to assess QOL. Results A total of 36 patients (LATG: 17, LAPG: 19) were enrolled. Four of 17 LATG patients (24%) were diagnosed with Stage ≥II after surgery, and half received S-1 adjuvant chemotherapy. BW and PNI were better maintained in LAPG than in LATG patients until 1-year follow-up. Seven of 16 LATG patients (44%) were categorized as “underweight (BMI<18.5 kg/m2)” at 1-year follow-up, compared to three of 18 LAPG patients (17%; p = 0.0836). The PGSAS-45 showed no significant difference in all QOL categories except for decreased BW (p = 0.0132). Multivariate analysis showed that LATG was the only potential risk factor for severe BW loss (odds ratio: 3.03, p = 0.0722). Conclusions LAPG with DFT was superior to LATG in postoperative nutritional maintenance, and can be the first option for early proximal gastric cancer.

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Retrospective Evaluation of Factors Affecting Lymph Node Retrieval Following Gastrectomies with Oncologic Intent

Rambam Maimonides Medical Journal ◽

10.5041/rmmj.10434 ◽

2021 ◽

Vol 12 (2) ◽

pp. e0012

Author(s):

Steven Fuchs ◽

◽

Itamar Ashkenazi ◽

◽

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Total Gastrectomy ◽

Medical Center ◽

Proximal Gastrectomy ◽

Univariate Analysis ◽

Related Factors ◽

Factors Affecting ◽

Lymph Node Retrieval ◽

Gastric Cancer Patients

Background: Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery. Methods: This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes. Results: The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differ¬ences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resec¬tion of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/prox¬imal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043). Discussion and Conclusion: In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.

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Proximal gastrectomy versus total gastrectomy for adenocarcinoma of the esophagogastric junction: a meta-analysis

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0016 ◽

2019 ◽

Vol 8 (10) ◽

pp. 753-766 ◽

Cited By ~ 1

Author(s):

Yi-chuan Chen ◽

Li Lu ◽

Kai-hu Fan ◽

Dao-han Wang ◽

Wei-hua Fu

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Survival Rate ◽

Total Gastrectomy ◽

Recurrence Rate ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Cochrane Library ◽

Overall Survival Rate ◽

Upper Third

Aim: To compare efficacy between total gastrectomy (TG) and proximal gastrectomy (PG) for upper-third gastric cancer. Materials & methods: PubMed, Embase and Cochrane library were searched to select suitable researches. Stata was used for meta-analysis including 5-year overall survival rate, recurrence rate, complication morbidities and serum nutritional levels. Results: Ten retrospective English researches were contained. Our study showed no significant difference of 5-year overall survival rate, recurrence rate, reflux symptoms and anastomotic leakage. TG experienced longer operation time, more lymph nodes-retrieved number, more estimated blood loss and higher ileus, but less anastomotic stricture. PG showed advantages over TG in terms of serum nutritional levels. Conclusion: PG is more preferable to TG for treatment of upper-third gastric cancer.

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