Nakane Kosuke, Fujiya Keiichi, Terashima Masanori, Kawabata Takanori, Matsumoto Yosuke, Kamiya Satoshi, Hikage Makoto, Tanizawa Yutaka, Ono Hiroyuki, Bando Etsuro
Division of Gastric Surgery Shizuoka Cancer Center Nagaizumi Japan.
Clinical Research Center Shizuoka Cancer Center Nagaizumi Japan.
Ann Gastroenterol Surg. 2022 Jan 25;6(4):486-495. doi: 10.1002/ags3.12546. eCollection 2022 Jul.
Esophagogastroduodenoscopy (EGD) may contribute to early detection of secondary cancer in the upper gastrointestinal tract although the clinical relevance of follow-up after gastrectomy remains unclear. This study aimed to elucidate the effectiveness of follow-up EGD by investigating the incidence of secondary cancer in any part of the upper gastrointestinal tract.
Data from 1438 patients who underwent curative partial gastrectomy for primary gastric cancer between 2008 and 2014 and follow-up EGD at least once during a 5-year follow-up period were retrospectively reviewed. Incidence rates of remnant gastric cancer, laryngeal cancer, and esophageal cancer detected after follow-up EGD were determined, and risk factors for secondary cancers were examined. The characteristics of clinicopathological diagnoses of secondary cancers were reviewed and compared according to the frequency of follow-up EGD.
The average annual frequency of EGD was 0.7, while the 5-year cumulative incidence rates of remnant gastric cancer and secondary laryngeal and esophageal cancers were 2.9% and 1.3%, respectively. Risk factors for remnant gastric cancer included heavy smoking, proximal gastrectomy, and tumor size ≥ 30 mm. All secondary cancers were resectable upon diagnosis, with endoscopically resectable cancer accounting for 81.0% of cases. Our results found a significantly higher proportion of endoscopically resectable cancers during regular follow-up than during infrequent follow-up.
Follow-up EGD can be a useful modality for detecting secondary upper gastrointestinal tract cancer, likely leading to curative treatment for secondary cancer. Focusing on patients presenting with risk factors may increase the value of follow-up EGD after gastrectomy.
尽管胃癌切除术后随访的临床意义尚不清楚，但食管胃十二指肠镜检查（EGD）可能有助于早期发现上消化道继发性癌症。本研究旨在通过调查上消化道任何部位继发性癌症的发生率来阐明随访EGD的有效性。
回顾性分析2008年至2014年间因原发性胃癌接受根治性部分胃切除术且在5年随访期内至少接受过一次随访EGD的1438例患者的数据。确定随访EGD后检测到的残胃癌、喉癌和食管癌的发生率，并检查继发性癌症的危险因素。根据随访EGD的频率，对上消化道继发性癌症的临床病理诊断特征进行回顾和比较。
EGD的年均频率为0.7，而残胃癌以及继发性喉癌和食管癌的5年累积发生率分别为2.9%和1.3%。残胃癌的危险因素包括大量吸烟、近端胃切除术和肿瘤大小≥30 mm。所有继发性癌症在诊断时均可切除，其中内镜下可切除的癌症占81.0%。我们的研究结果发现，定期随访期间内镜下可切除癌症的比例明显高于不定期随访期间。
随访EGD可能是检测上消化道继发性癌症的一种有用方法，可能会使继发性癌症得到根治性治疗。关注有危险因素的患者可能会提高胃癌切除术后随访EGD的价值。
