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Abstract：
OBJECTIVE: Despite annual endoscopy, patients with metachronous remnant gastric cancer (MRGC) following proximal gastrectomy (PG) are at times ineligible for endoscopic resection (ER). This study aimed to clarify the clinical risk factors for ER inapplicability.
METHODS: We reviewed the records of 203 patients who underwent PG for cT1 gastric cancer between 2006 and 2015. The remnant stomach was categorized as a pseudofornix, corpus, or antrum.
RESULTS: Thirty-two MRGCs were identified in the 29 patients. Twenty MRGCs were classified as ER (ER group, 62.5%), whereas 12 were not (non-ER group, 37.5%). MRGCs were located in the pseudo-fornix in 1, corpus in 5, and antrum in 14 in the ER group, and in the pseudo-fornix in 6, corpus in 4, and antrum in 2 in the non-ER group (P=0.019). Multivariate analysis revealed that the pseudo-fornix was an independent risk factor for non-ER (P=0.014). In the non-ER group, MRGCs at the pseudo-fornix (n=6) had more frequent undifferentiated-type histology (4/6 vs. 0/6), deeper (≥pT1b2; 6/6 vs. 2/6) and nodal metastasis (3/6 vs. 0/6) than non-pseudo-fornix lesions (n=6). We examined the visibility of the region developing MRGC on an annual follow-up endoscopy one year before MRGC detection. In seven lesions at the pseudofornix, visibility was only secured in two (28.6%) because of food residues. Of the 25 lesions in the non-pseudo-fornix, visibility was secured in 21 lesions (84%; P=0.010).
CONCLUSIONS: Endoscopic visibility increases the chances of ER applicability. Special preparation is required to ensure the complete clearance of food residues in the pseudo-fornix.
METHODS: We reviewed the records of 203 patients who underwent PG for cT1 gastric cancer between 2006 and 2015. The remnant stomach was categorized as a pseudofornix, corpus, or antrum.
RESULTS: Thirty-two MRGCs were identified in the 29 patients. Twenty MRGCs were classified as ER (ER group, 62.5%), whereas 12 were not (non-ER group, 37.5%). MRGCs were located in the pseudo-fornix in 1, corpus in 5, and antrum in 14 in the ER group, and in the pseudo-fornix in 6, corpus in 4, and antrum in 2 in the non-ER group (P=0.019). Multivariate analysis revealed that the pseudo-fornix was an independent risk factor for non-ER (P=0.014). In the non-ER group, MRGCs at the pseudo-fornix (n=6) had more frequent undifferentiated-type histology (4/6 vs. 0/6), deeper (≥pT1b2; 6/6 vs. 2/6) and nodal metastasis (3/6 vs. 0/6) than non-pseudo-fornix lesions (n=6). We examined the visibility of the region developing MRGC on an annual follow-up endoscopy one year before MRGC detection. In seven lesions at the pseudofornix, visibility was only secured in two (28.6%) because of food residues. Of the 25 lesions in the non-pseudo-fornix, visibility was secured in 21 lesions (84%; P=0.010).
CONCLUSIONS: Endoscopic visibility increases the chances of ER applicability. Special preparation is required to ensure the complete clearance of food residues in the pseudo-fornix.
摘要：
目标：尽管每年进行内窥镜检查，近端胃切除术(PG)后异时性残胃癌(MRGC)患者有时不适合进行内镜切除术(ER).本研究旨在阐明ER不适用的临床危险因素。
方法：我们回顾了2006年至2015年间因cT1胃癌而接受PG治疗的203例患者的记录。剩余的胃被归类为假穹窿，语料库，或者胃窦.
结果：在29例患者中发现32例MRGC。20个MRGC被归类为ER(ER组，62.5%），而12个不是(非ER组，37.5%）。在ER组中，MRGC位于1个假穹窿，5个语料库和14个胃窦。在非ER组中，在6个假穹窿中，在4个语料库中，在2个胃窦中（P=0.019）。多因素分析显示,假穹窿是非ER的独立危险因素(P=0.014)。在非ER组中，假穹窿（n=6）的MRGC具有更频繁的未分化型组织学（4/6vs.0/6),更深(≥pT1b2；6/6vs.2/6）和淋巴结转移（3/6vs.0/6）比非假性穹窿病变（n=6）。我们在MRGC检测前一年的年度随访内窥镜检查中检查了发展MRGC的区域的可见性。在假穹窿的七个病变中，由于食物残渣，能见度只有两个(28.6%)。在非假穹窿的25个病变中，在21个病灶中可见性得到了保证(84%;P=0.010).
结论：内窥镜可见性增加了ER适用性的机会。需要特殊的准备，以确保完全清除假穹窿中的食物残渣。
方法：我们回顾了2006年至2015年间因cT1胃癌而接受PG治疗的203例患者的记录。剩余的胃被归类为假穹窿，语料库，或者胃窦.
结果：在29例患者中发现32例MRGC。20个MRGC被归类为ER(ER组，62.5%），而12个不是(非ER组，37.5%）。在ER组中，MRGC位于1个假穹窿，5个语料库和14个胃窦。在非ER组中，在6个假穹窿中，在4个语料库中，在2个胃窦中（P=0.019）。多因素分析显示,假穹窿是非ER的独立危险因素(P=0.014)。在非ER组中，假穹窿（n=6）的MRGC具有更频繁的未分化型组织学（4/6vs.0/6),更深(≥pT1b2；6/6vs.2/6）和淋巴结转移（3/6vs.0/6）比非假性穹窿病变（n=6）。我们在MRGC检测前一年的年度随访内窥镜检查中检查了发展MRGC的区域的可见性。在假穹窿的七个病变中，由于食物残渣，能见度只有两个(28.6%)。在非假穹窿的25个病变中，在21个病灶中可见性得到了保证(84%;P=0.010).
结论：内窥镜可见性增加了ER适用性的机会。需要特殊的准备，以确保完全清除假穹窿中的食物残渣。
