Evaluating the Need for Additional Surgery After Non-Curative Endoscopic Resection in Patients with Remnant Gastric...

Completion total gastrectomy is considered an additional treatment after non-curative endoscopic resection for remnant gastric cancer. However, its high invasiveness remains a concern. This study aimed to assess the necessity of additional surgery after non-curative endoscopic submucosal dissection in patients with remnant gastric cancer.

This study included patients who underwent non-curative endoscopic submucosal dissection for remnant gastric cancer between September 2002 and January 2018. The eCura system was used to stratify the risk of lymph node metastasis into low, intermediate, or high. The overall survival, disease-specific survival, and long-term clinical course were analyzed.

Among the 46 patients analyzed, 15 underwent additional completion total gastrectomy, whereas 31 were only followed up. Within a median follow-up period of 62.5 months, the additional surgery and follow-up groups showed 5-year overall survival rates of 79.4% and 76.8% (P = 0.93) and disease-specific survival rates of 92.9% and 92.7% (P = 0.98). A total of 19 low-, 8 intermediate-, and 4 high-risk patients in the follow-up group achieved 5-year disease-specific survival rates of 100%, 100%, and 33.3%. Significant differences were observed in the disease-specific survival between the low- and high-risk patients (P < 0.001) and between the intermediate- and high-risk patients (P = 0.02).

Risk stratification using the eCura system allows for individualized treatment decisions, with follow-up being a viable option for low- and intermediate-risk patients and additional surgery recommended for high-risk patients after non-curative endoscopic submucosal dissection for remnant gastric cancer.