The risk scoring system for assessing the technical difficulty of endoscopic submucosal dissection in cases of remnant gastric cancer after distal gastrectomy.
Distal gastrectomy
Endoscopic submucosal dissection
Gastric cancer
Remnant stomach
Risk-scoring system
Technical difficulty
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
15
08
2020
accepted:
05
03
2021
pubmed:
15
4
2021
medline:
4
3
2022
entrez:
14
4
2021
Statut:
ppublish
Résumé
Endoscopic submucosal dissection (ESD) for remnant gastric cancer (RGC) after distal gastrectomy (DG) is considered technically challenging due to the narrow working space, and severe fibrosis and staples from the previous surgery. Technical difficulties of ESD for RGC after DG have not been thoroughly investigated. This study aimed to develop and validate a risk-scoring system for assessing the technical difficulty of ESD for RGC after DG in a large multicenter cohort. We investigated patients who underwent ESD for RGC after DG in 10 institutions between April 2008 and March 2018. A difficult case was defined as ESD lasting ≥ 120 min, involving piecemeal resection, or the occurrence of perforation during the procedure. A risk-scoring system for the technical difficulty of the procedure was developed based on multiple logistic regression analyses, and its performance was internally validated using bootstrapping. A total of 197 consecutive patients with 201 lesions were analyzed. There were 90 and 111 difficult and non-difficult cases, respectively. The scoring model consisted of four independent risk factors and points of risk scores were assigned for each as follows: tumor size > 20 mm: 2 points; anastomosis site: 2 points; suture line: 1 point; and non-expert endoscopist: 2 points. The C-statistics of the scoring system for technical difficulty was 0.72. We developed a validated risk-scoring model for predicting the technical difficulty of ESD for RGC after DG that can contribute to its safer and more reliable performance.
Sections du résumé
BACKGROUND
Endoscopic submucosal dissection (ESD) for remnant gastric cancer (RGC) after distal gastrectomy (DG) is considered technically challenging due to the narrow working space, and severe fibrosis and staples from the previous surgery. Technical difficulties of ESD for RGC after DG have not been thoroughly investigated. This study aimed to develop and validate a risk-scoring system for assessing the technical difficulty of ESD for RGC after DG in a large multicenter cohort.
METHODS
We investigated patients who underwent ESD for RGC after DG in 10 institutions between April 2008 and March 2018. A difficult case was defined as ESD lasting ≥ 120 min, involving piecemeal resection, or the occurrence of perforation during the procedure. A risk-scoring system for the technical difficulty of the procedure was developed based on multiple logistic regression analyses, and its performance was internally validated using bootstrapping.
RESULTS
A total of 197 consecutive patients with 201 lesions were analyzed. There were 90 and 111 difficult and non-difficult cases, respectively. The scoring model consisted of four independent risk factors and points of risk scores were assigned for each as follows: tumor size > 20 mm: 2 points; anastomosis site: 2 points; suture line: 1 point; and non-expert endoscopist: 2 points. The C-statistics of the scoring system for technical difficulty was 0.72.
CONCLUSIONS
We developed a validated risk-scoring model for predicting the technical difficulty of ESD for RGC after DG that can contribute to its safer and more reliable performance.
Identifiants
pubmed: 33852062
doi: 10.1007/s00464-021-08433-x
pii: 10.1007/s00464-021-08433-x
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1482-1489Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386
doi: 10.1002/ijc.29210
Choi KS, Jun JK, Suh M et al (2015) Effect of endoscopy screening on stage at early gastric cancer diagnosis: results of the national cancer screening programme in Korea. Br J Cancer 112:608–612
doi: 10.1038/bjc.2014.608
Hamashima C, Ogoshi K, Okamoto M et al (2013) A community based, case–control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. PLoS ONE 8:e79088
doi: 10.1371/journal.pone.0079088
Balfour DC (1922) Factors influencing the life expectancy of patients operated on for gastric ulcer. Ann Surg 76:405–408
doi: 10.1097/00000658-192209000-00014
Fisher SG, Davis F, Nelson R et al (1993) A cohort study of stomach cancer risk in men after gastric surgery for benign disease. J Natl Cancer Inst 85:1303–1310
doi: 10.1093/jnci/85.16.1303
Toftgaard C (1989) Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg 210:159–64
doi: 10.1097/00000658-198908000-00004
Ahn HS, Kim JW, Yoo MW et al (2008) Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol 15:1632–1639
doi: 10.1245/s10434-008-9871-8
Irino T, Hiki N, Ohashi M et al (2016) Characteristics of gastric stump cancer: a single hospital retrospective analysis of 262 patients. Surgery 159:1539–1547
doi: 10.1016/j.surg.2016.01.003
Nakagawa M, Choi YY, An JY et al (2016) Staging for remnant gastric cancer: the metastatic lymph node ratio vs. the UICC 7th edition system. Ann Surg Oncol 23:4322–4331
doi: 10.1245/s10434-016-5390-1
Hanyu T, Wakai A, Ishikawa T et al (2018) Carcinoma in the remnant stomach during long-term follow-up after distal gastrectomy for gastric cancer: analysis of cumulative incidence and associated risk factors. World J Surg 42:782–787
doi: 10.1007/s00268-017-4227-9
Ikeda Y, Saku M, Kishihara F et al (2005) Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer. Br J Surg 92:235–239
doi: 10.1002/bjs.4758
Onodera H, Tokunaga A, Yoshiyuki T et al (2004) Surgical outcome of 483 patients with early gastric cancer: prognosis, postoperative morbidity and mortality, and gastric remnant cancer. Hepatogastroenterology 51:82–85
pubmed: 15011835
Nozaki I, Nasu J, Kubo Y et al (2010) Risk factors for metachronous gastric cancer in the remnant stomach after early cancer surgery. World J Surg 34:1548–1554
doi: 10.1007/s00268-010-0518-0
Tanaka M, Ono H, Hasuike N et al (2008) Endoscopic submucosal dissection of early gastric cancer. Digestion 77:23–28
doi: 10.1159/000111484
Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11
doi: 10.1007/s10120-006-0408-1
Ono H, Kondo H, Gotoda T et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229
doi: 10.1136/gut.48.2.225
Choi IJ, Lee JH, Kim YI et al (2015) Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. Gastrointest Endosc 81:333–341
doi: 10.1016/j.gie.2014.07.047
Hoteya S, Iizuka T, Kikuchi D et al (2010) Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection. Dig Endosc 22:17–20
doi: 10.1111/j.1443-1661.2009.00912.x
Hirasaki S, Kanzaki H, Matsubara M et al (2008) Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife. World J Gastroenterol 14:2550–2555
doi: 10.3748/wjg.14.2550
Takenaka R, Kawahara Y, Okada H et al (2008) Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 67:359–363
doi: 10.1016/j.gie.2007.10.021
Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19
doi: 10.1007/s10120-016-0622-4
Yano T, Hasuike N, Ono H et al (2020) Factors associated with technical difficulty of endoscopic submucosal dissection for early gastric cancer that met the expanded indication criteria: post hoc analysis of a multi-institutional prospective confirmatory trial (JCOG0607). Gastric Cancer 23:168–174
doi: 10.1007/s10120-019-00991-3
Toyonaga T, Man-I M, Fujita T et al (2010) The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study. Aliment Pharmacol Ther 32:908–915
doi: 10.1111/j.1365-2036.2010.04425.x
Sullivan LM, Massaro JM, D’Agostino RB (2004) Presentation of multivariate data for clinical use: the Framingham Study risk score function. Stat Med 23:1631–1660
doi: 10.1002/sim.1742
Chung IK, Lee JH, Lee SH et al (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235
doi: 10.1016/j.gie.2008.09.027
Kim M, Jeon SW, Cho KB et al (2013) Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Daegu-Kyungpook Gastrointestinal Study Group (DGSG). Surg Endosc 27:1372–8
doi: 10.1007/s00464-012-2618-4
Littler ER, Gleibermann E (1972) Gastritis cystica polyposa. (Gastric mucosal prolapse at gastroenterostomy site, with cystic and infiltrative epithelial hyperplasia). Cancer 29:205–9
doi: 10.1002/1097-0142(197201)29:1<205::AID-CNCR2820290130>3.0.CO;2-J
Yabuuchi Y, Kakushima N, Takizawa K et al (2019) Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. J Gastroenterol 54:511–520
doi: 10.1007/s00535-018-1528-1
Tanaka S, Toyonaga T, Morita Y et al (2014) Endoscopic submucosal dissection for early gastric cancer in anastomosis site after distal gastrectomy. Gastric Cancer 17:371–376
doi: 10.1007/s10120-013-0283-5
Suzuki H, Takizawa K, Hirasawa T et al (2019) Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: “real-world evidence” in Japan. Dig Endosc 31:30–39
doi: 10.1111/den.13246