Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy
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Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Differentreconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomoticsite. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastriccancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at theanastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm;p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation timewas longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth IIgroup. Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with abackground of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involvedlonger operative times and more frequent bleeding episodes than that in patients without Billroth II.
Abstract
Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Differentreconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomoticsite. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastriccancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at theanastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm;p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation timewas longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth IIgroup. Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with abackground of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involvedlonger operative times and more frequent bleeding episodes than that in patients without Billroth II.
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