Safety of pylorus-preserving gastrectomy for gastric cancer combined with antral high-risk lesions: a comparison with endoscopic submucosal dissection
Background Pylorus-preserving gastrectomy (PPG) is a surgical treatment option for cT1N0M0 gastric cancer located in the middle third of the stomach. However, data for the long-term post-PPG clinical outcomes related to metachronous gastric neoplasms (mGNs) in the residual stomach are currently lack...
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| Veröffentlicht in: | Surgical endoscopy 2023-04, Vol.37 (4), p.2987-2996 |
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| creator | Choi, Jinju Kim, Sara Chung, Hyunsoo Kong, Seong-Ho Cho, Soo-Jeong Park, Do-Joong Lee, Hyuk-Joon Kim, Sang Gyun Yang, Han-Kwang |
| description | Background
Pylorus-preserving gastrectomy (PPG) is a surgical treatment option for cT1N0M0 gastric cancer located in the middle third of the stomach. However, data for the long-term post-PPG clinical outcomes related to metachronous gastric neoplasms (mGNs) in the residual stomach are currently lacking. Therefore, we aimed to evaluate the safety of PPG by focusing on mGNs.
Methods
In this single-center, retrospective study, we reviewed the data for 362 patients who underwent PPG with a 3-cm antral cuff and 139 who underwent endoscopic submucosal dissection (ESD) for middle-third gastric cancer between January 2013 and December 2015. The histopathologic features of the antrum in the ESD group, which could not be determined in the PPG group, were analyzed to investigate the risk factors for mGNs. The estimated and actual incidence of mGNs in the antrum were compared in the PPG group.
Results
The incidence of mGNs was 6.5% (9/139) in the ESD group. The presence of a synchronous adenoma (odds ratio [OR], 8.46; 95% confidence interval [CI], 1.55–46.34), carcinoma (OR, 15.71; 95% CI, 2.67–92.56) and moderate-to-severe intestinal metaplasia (OR, 9.77; 95% CI, 1.14–83.92) were associated with a higher risk of overall mGNs. However, when confined to the antrum, no significant association was observed between these factors and mGNs. In the ESD group, 2 of 9 mGNs (1.4%) were located at the 3-cm antral cuff. In the PPG group, both mGNs (0.6%) were located in the proximal remnant stomach.
Conclusion
Pylorus-preserving gastrectomy was a safe therapeutic option with regard to the occurrence of metachronous adenomas or carcinomas in our series. Despite the low mGN incidence in the 3-cm antral cuff after PPG, the presence of synchronous neoplasms or moderate-to-severe intestinal metaplasia was a risk factor for mGNs in the ESD group; thus, further studies on longer antral cuffs with long-term follow-up are needed. |
| doi_str_mv | 10.1007/s00464-022-09791-w |
| format | Article |
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Pylorus-preserving gastrectomy (PPG) is a surgical treatment option for cT1N0M0 gastric cancer located in the middle third of the stomach. However, data for the long-term post-PPG clinical outcomes related to metachronous gastric neoplasms (mGNs) in the residual stomach are currently lacking. Therefore, we aimed to evaluate the safety of PPG by focusing on mGNs.
Methods
In this single-center, retrospective study, we reviewed the data for 362 patients who underwent PPG with a 3-cm antral cuff and 139 who underwent endoscopic submucosal dissection (ESD) for middle-third gastric cancer between January 2013 and December 2015. The histopathologic features of the antrum in the ESD group, which could not be determined in the PPG group, were analyzed to investigate the risk factors for mGNs. The estimated and actual incidence of mGNs in the antrum were compared in the PPG group.
Results
The incidence of mGNs was 6.5% (9/139) in the ESD group. The presence of a synchronous adenoma (odds ratio [OR], 8.46; 95% confidence interval [CI], 1.55–46.34), carcinoma (OR, 15.71; 95% CI, 2.67–92.56) and moderate-to-severe intestinal metaplasia (OR, 9.77; 95% CI, 1.14–83.92) were associated with a higher risk of overall mGNs. However, when confined to the antrum, no significant association was observed between these factors and mGNs. In the ESD group, 2 of 9 mGNs (1.4%) were located at the 3-cm antral cuff. In the PPG group, both mGNs (0.6%) were located in the proximal remnant stomach.
Conclusion
Pylorus-preserving gastrectomy was a safe therapeutic option with regard to the occurrence of metachronous adenomas or carcinomas in our series. Despite the low mGN incidence in the 3-cm antral cuff after PPG, the presence of synchronous neoplasms or moderate-to-severe intestinal metaplasia was a risk factor for mGNs in the ESD group; thus, further studies on longer antral cuffs with long-term follow-up are needed.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09791-w</identifier><identifier>PMID: 36517703</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Carcinoma ; Endoscopic Mucosal Resection - adverse effects ; Endoscopy ; Gastrectomy ; Gastric cancer ; Gastric Mucosa - surgery ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Proctology ; Pylorus - surgery ; Retrospective Studies ; Stomach Neoplasms - surgery ; Surgery ; Surgical outcomes ; Treatment Outcome ; Tumors</subject><ispartof>Surgical endoscopy, 2023-04, Vol.37 (4), p.2987-2996</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-c36ce2a031336dab1e9657cbba6f6580c8c708693b3666a791ce77a0c4ff8d873</cites><orcidid>0000-0001-5159-357X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09791-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09791-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36517703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Choi, Jinju</creatorcontrib><creatorcontrib>Kim, Sara</creatorcontrib><creatorcontrib>Chung, Hyunsoo</creatorcontrib><creatorcontrib>Kong, Seong-Ho</creatorcontrib><creatorcontrib>Cho, Soo-Jeong</creatorcontrib><creatorcontrib>Park, Do-Joong</creatorcontrib><creatorcontrib>Lee, Hyuk-Joon</creatorcontrib><creatorcontrib>Kim, Sang Gyun</creatorcontrib><creatorcontrib>Yang, Han-Kwang</creatorcontrib><title>Safety of pylorus-preserving gastrectomy for gastric cancer combined with antral high-risk lesions: a comparison with endoscopic submucosal dissection</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Pylorus-preserving gastrectomy (PPG) is a surgical treatment option for cT1N0M0 gastric cancer located in the middle third of the stomach. However, data for the long-term post-PPG clinical outcomes related to metachronous gastric neoplasms (mGNs) in the residual stomach are currently lacking. Therefore, we aimed to evaluate the safety of PPG by focusing on mGNs.
Methods
In this single-center, retrospective study, we reviewed the data for 362 patients who underwent PPG with a 3-cm antral cuff and 139 who underwent endoscopic submucosal dissection (ESD) for middle-third gastric cancer between January 2013 and December 2015. The histopathologic features of the antrum in the ESD group, which could not be determined in the PPG group, were analyzed to investigate the risk factors for mGNs. The estimated and actual incidence of mGNs in the antrum were compared in the PPG group.
Results
The incidence of mGNs was 6.5% (9/139) in the ESD group. The presence of a synchronous adenoma (odds ratio [OR], 8.46; 95% confidence interval [CI], 1.55–46.34), carcinoma (OR, 15.71; 95% CI, 2.67–92.56) and moderate-to-severe intestinal metaplasia (OR, 9.77; 95% CI, 1.14–83.92) were associated with a higher risk of overall mGNs. However, when confined to the antrum, no significant association was observed between these factors and mGNs. In the ESD group, 2 of 9 mGNs (1.4%) were located at the 3-cm antral cuff. In the PPG group, both mGNs (0.6%) were located in the proximal remnant stomach.
Conclusion
Pylorus-preserving gastrectomy was a safe therapeutic option with regard to the occurrence of metachronous adenomas or carcinomas in our series. Despite the low mGN incidence in the 3-cm antral cuff after PPG, the presence of synchronous neoplasms or moderate-to-severe intestinal metaplasia was a risk factor for mGNs in the ESD group; thus, further studies on longer antral cuffs with long-term follow-up are needed.</description><subject>Abdominal Surgery</subject><subject>Carcinoma</subject><subject>Endoscopic Mucosal Resection - adverse effects</subject><subject>Endoscopy</subject><subject>Gastrectomy</subject><subject>Gastric cancer</subject><subject>Gastric Mucosa - surgery</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Pylorus - surgery</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1u1TAQhS0EoreFF2CBLLFhE_Bf7IQdqoAiVWIBrC3HmdzrktjBk_TqvgjPi0sKSCzY2PL4O2dGcwh5xtkrzph5jYwprSomRMVa0_Lq-IDsuJKiEoI3D8mOtZJVwrTqjJwj3rDCt7x-TM6krrkxTO7Ij89ugOVE00Dn05jyitWcASHfhrine4dLBr-k6USHlLd38NS76CFTn6YuROjpMSwH6uKS3UgPYX-ocsBvdAQMKeIb6u7I2ZViihsLsU_o01y8cO2m1Scs0j4glm5F9IQ8GtyI8PT-viBf37_7cnlVXX_68PHy7XXlpdBLObUH4ZjkUuredRxaXRvfdU4Pum6Yb7xhjW5lJ7XWruzIgzGOeTUMTd8YeUFebr5zTt9XwMVOAT2Mo4uQVrTC1KqpG2NkQV_8g96kNccyXaFao2rOlCqU2CifE2KGwc45TC6fLGf2LjW7pWZLavZXavZYRM_vrcsuoP8j-R1TAeQGYPmKe8h_e__H9icKJ6bK</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Choi, Jinju</creator><creator>Kim, Sara</creator><creator>Chung, Hyunsoo</creator><creator>Kong, Seong-Ho</creator><creator>Cho, Soo-Jeong</creator><creator>Park, Do-Joong</creator><creator>Lee, Hyuk-Joon</creator><creator>Kim, Sang Gyun</creator><creator>Yang, Han-Kwang</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5159-357X</orcidid></search><sort><creationdate>20230401</creationdate><title>Safety of pylorus-preserving gastrectomy for gastric cancer combined with antral high-risk lesions: a comparison with endoscopic submucosal dissection</title><author>Choi, Jinju ; Kim, Sara ; Chung, Hyunsoo ; Kong, Seong-Ho ; Cho, Soo-Jeong ; Park, Do-Joong ; Lee, Hyuk-Joon ; Kim, Sang Gyun ; Yang, Han-Kwang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-c36ce2a031336dab1e9657cbba6f6580c8c708693b3666a791ce77a0c4ff8d873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Carcinoma</topic><topic>Endoscopic Mucosal Resection - adverse effects</topic><topic>Endoscopy</topic><topic>Gastrectomy</topic><topic>Gastric cancer</topic><topic>Gastric Mucosa - surgery</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Pylorus - surgery</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Choi, Jinju</creatorcontrib><creatorcontrib>Kim, Sara</creatorcontrib><creatorcontrib>Chung, Hyunsoo</creatorcontrib><creatorcontrib>Kong, Seong-Ho</creatorcontrib><creatorcontrib>Cho, Soo-Jeong</creatorcontrib><creatorcontrib>Park, Do-Joong</creatorcontrib><creatorcontrib>Lee, Hyuk-Joon</creatorcontrib><creatorcontrib>Kim, Sang Gyun</creatorcontrib><creatorcontrib>Yang, Han-Kwang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Choi, Jinju</au><au>Kim, Sara</au><au>Chung, Hyunsoo</au><au>Kong, Seong-Ho</au><au>Cho, Soo-Jeong</au><au>Park, Do-Joong</au><au>Lee, Hyuk-Joon</au><au>Kim, Sang Gyun</au><au>Yang, Han-Kwang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety of pylorus-preserving gastrectomy for gastric cancer combined with antral high-risk lesions: a comparison with endoscopic submucosal dissection</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>37</volume><issue>4</issue><spage>2987</spage><epage>2996</epage><pages>2987-2996</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Pylorus-preserving gastrectomy (PPG) is a surgical treatment option for cT1N0M0 gastric cancer located in the middle third of the stomach. However, data for the long-term post-PPG clinical outcomes related to metachronous gastric neoplasms (mGNs) in the residual stomach are currently lacking. Therefore, we aimed to evaluate the safety of PPG by focusing on mGNs.
Methods
In this single-center, retrospective study, we reviewed the data for 362 patients who underwent PPG with a 3-cm antral cuff and 139 who underwent endoscopic submucosal dissection (ESD) for middle-third gastric cancer between January 2013 and December 2015. The histopathologic features of the antrum in the ESD group, which could not be determined in the PPG group, were analyzed to investigate the risk factors for mGNs. The estimated and actual incidence of mGNs in the antrum were compared in the PPG group.
Results
The incidence of mGNs was 6.5% (9/139) in the ESD group. The presence of a synchronous adenoma (odds ratio [OR], 8.46; 95% confidence interval [CI], 1.55–46.34), carcinoma (OR, 15.71; 95% CI, 2.67–92.56) and moderate-to-severe intestinal metaplasia (OR, 9.77; 95% CI, 1.14–83.92) were associated with a higher risk of overall mGNs. However, when confined to the antrum, no significant association was observed between these factors and mGNs. In the ESD group, 2 of 9 mGNs (1.4%) were located at the 3-cm antral cuff. In the PPG group, both mGNs (0.6%) were located in the proximal remnant stomach.
Conclusion
Pylorus-preserving gastrectomy was a safe therapeutic option with regard to the occurrence of metachronous adenomas or carcinomas in our series. Despite the low mGN incidence in the 3-cm antral cuff after PPG, the presence of synchronous neoplasms or moderate-to-severe intestinal metaplasia was a risk factor for mGNs in the ESD group; thus, further studies on longer antral cuffs with long-term follow-up are needed.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36517703</pmid><doi>10.1007/s00464-022-09791-w</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5159-357X</orcidid></addata></record> |
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| subjects | Abdominal Surgery Carcinoma Endoscopic Mucosal Resection - adverse effects Endoscopy Gastrectomy Gastric cancer Gastric Mucosa - surgery Gastroenterology Gastrointestinal surgery Gynecology Hepatology Humans Medicine Medicine & Public Health Proctology Pylorus - surgery Retrospective Studies Stomach Neoplasms - surgery Surgery Surgical outcomes Treatment Outcome Tumors |
| title | Safety of pylorus-preserving gastrectomy for gastric cancer combined with antral high-risk lesions: a comparison with endoscopic submucosal dissection |
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