Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan.
Department of Gastroenterology, Yokohama City University, Yokohama, Kanagawa, 236-0004, Japan.
Surg Endosc. 2022 Nov;36(11):8096-8106. doi: 10.1007/s00464-022-09240-8. Epub 2022 May 23.
Gastric tube cancer (GTC), whose usual histology is adenocarcinoma, occurs frequently as a result of improved survival after esophagectomy. Whether endoscopic resection (ER) for GTC is safe and suitable and guidelines for treatment and follow-up remains unclear.
Patients with GTC who underwent ER at Kanagawa Cancer Center Hospital between 1997 and 2020 were studied retrospectively to evaluate clinical characteristics and short- and long-term outcomes.
Twenty-two consecutive patients with 43 lesions were treated in 42 sessions of ER. Lesions were discovered at a median of 9.0 (0-21.8) years after esophageal surgery. Nine (40.9%) patients had multiple lesions at the time of the initial ER session. However, six (54.5%) of the 11 co-existing lesions were overlooked. The location of the middle third was an estimated risk factor for overlooking (p = 0.028). In endoscopic submucosal dissection (ESD) cases, the en bloc dissection rate was as high as 97.1%, and the rates of bleeding, perforation, and aspiration pneumonitis were 17.6%, 0%, and 2.9%, respectively. The bleeding rate was relatively higher than that in usual gastric ESD. Twelve patients (54.5%) experienced synchronous and/or metachronous multiple GTCs during their life span. Thirteen (61.9%) patients died during the median follow-up period of 5.9 (0.7-15.5) years. One patient (7.7%) died of GTC recurrence, 15.4 years after the initial non-curative ER date; 3 (23.1%) patients died of esophageal cancer recurrence, and 3 (23.1%) died of other organ malignancies. The 5-year overall survival rate was 85.0%, and the 5-year disease-specific survival rate was 100%.
ER is feasible for GTCs. However, the rate of bleeding was high in ESD cases. Life-long endoscopic screening of metachronous lesions is desirable. Care should be taken not to overlook lesions in the middle third of the gastric tube. Early detection of esophageal cancer recurrence and other organ malignancies may improve prognosis.
胃管癌（GTC）通常组织学类型为腺癌，是食管癌手术后生存改善的结果。对于 GTC，内镜下切除（ER）是否安全且合适，以及治疗和随访的指南尚不清楚。
回顾性研究了 1997 年至 2020 年间在神奈川癌症中心医院接受 ER 治疗的 GTC 患者，以评估其临床特征和短期及长期结局。
22 例连续患者在 42 次 ER 治疗中共计 43 个病变。病变在食管手术后中位数 9.0（0-21.8）年后发现。初次 ER 时，9 例（40.9%）患者有多个病变。然而，11 个共存病变中有 6 个（54.5%）被忽略。病变位于胃管中段是忽略病变的一个估计危险因素（p=0.028）。在内镜黏膜下剥离术（ESD）病例中，整块切除率高达 97.1%，出血、穿孔和吸入性肺炎的发生率分别为 17.6%、0%和 2.9%。出血率相对高于一般胃 ESD。12 例患者（54.5%）在其一生中经历了同步和/或异时性多发 GTC。在中位随访 5.9（0.7-15.5）年期间，13 例（61.9%）患者死亡。1 例（7.7%）患者在初次非治愈性 ER 后 15.4 年死于 GTC 复发；3 例（23.1%）患者死于食管癌复发，3 例（23.1%）死于其他器官恶性肿瘤。5 年总生存率为 85.0%，5 年疾病特异性生存率为 100%。
ER 适用于 GTC。然而，ESD 病例出血率较高。有必要对胃管的异时性病变进行终身内镜筛查。应注意不要忽略胃管中段的病变。早期发现食管癌复发和其他器官恶性肿瘤可能改善预后。
