Journal of Gastric Cancer最新文献

This corrects the article on p. 280 in vol. 24, PMID: 38960887.

Purpose: Accurate measurement of the lesion size during endoscopy is crucial; however, it frequently relies on visual estimation, which is prone to errors. This study investigated these inaccuracies and introduced a novel depth-estimation algorithm (DEA) to evaluate its performance against conventional methods, visual estimation, and forceps-assisted estimation.

Materials and methods: Nineteen endoscopists (6 experts, 13 novices) measured 15 artificial lesions (6-39 mm) within a 3-dimensional (3D)-printed stomach model using visual estimation (VE), forceps-assisted estimation (FE), and DEA. Measurement accuracy was evaluated using median percentage error (MdPE) and interquartile range (IQR). Subgroup analyses were conducted according to the endoscopist's experience and lesion size, location, and shape for each measurement method.

Results: VE resulted in the highest MdPE at 33.33% (IQR, 17.24%-60.00%), while FE showed greater accuracy at 30.00% (IQR, 11.11%-48.72%; P<0.01). Unlike experts, novices exhibited no significant improvement in FE compared to VE (P=0.09). Conventional methods have demonstrated high error rates for polyp-shaped lesions and those located in the fundus, middle to high body, or the greater curvature. DEA achieved the highest accuracy, with an MdPE of 7.78% (IQR, 3.33%-16.67%), significantly outperforming both VE and FE (P<0.01) regardless of lesion characteristics, and showed consistent performance across endoscopist experience (P=0.18).

Conclusions: Given the observed error patterns in VE, endoscopists should exercise caution when evaluating polyp-shaped lesions and those located in the proximal stomach and greater curvature. The DEA outperformed conventional methods, especially for novices. Its integration into endoscopic practice can enhance the precision of lesion size measurements, ultimately improving clinical decision-making and outcomes.

Peritoneal metastasis (PM) from gastric cancer is a critical determinant of poor prognosis and has limited therapeutic options. However, recent advances in diagnostic and therapeutic strategies have reshaped the clinical landscape, enabling curative treatment of select patients. Accurate staging based on the peritoneal cancer index (PCI) is central to disease stratification and treatment planning. A PCI threshold of ≤6 has emerged as a consensus-based cutoff to define peritoneal oligometastasis, a limited metastatic state with potential for long-term survival following aggressive multimodal therapy. Therefore, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy remains the cornerstone of curative treatment. Additionally, innovative peritoneum-directed therapies-including normothermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy, and pressurized intraperitoneal aerosol chemotherapy- have expanded the therapeutic landscape for both curative and palliative indications. This review highlights the evolving strategies for the diagnosis and treatment of gastric cancer with PM, with emphasis on PCI-based patient selection and treatment optimization. We also discuss the future roles of liquid biopsy, artificial intelligence, and photodynamic therapy in enhancing precision oncology for PM. Defining and targeting peritoneal oligometastases may enable tailored interventions and improve outcomes of this historically intractable disease.

Purpose: This study aimed to analyze the rate of adequate observation of the remnant stomach after proximal gastrectomy (PG) with double-tract reconstruction (DTR).

Materials and methods: Data from patients who underwent PG with DTR for gastric cancer at 6 institutions in South Korea were included. The clinicopathological and serial endoscopic data were retrospectively analyzed. Successful surveillance endoscopy was defined as photographic documentation of the pyloric antrum. Factors associated with successful endoscopy were analyzed using a mixed-effects logistic regression model.

Results: In total, 634 surveillance endoscopies were performed in 160 patients after they underwent PG with DTR. The median time from surgery to endoscopy was 17.5 months (range, 0-137 months). The overall success rate of endoscopy was 75.6%. The mean total procedure time for successful endoscopies was 439.4±336.0 seconds, compared with 373.7±326.0 seconds for failed examinations (P=0.033). Although 31.9% of the patients experienced failure during their first endoscopy, all but 3 patients achieved at least one successful endoscopy by the fourth session. Factors associated with successful endoscopy included longer procedure time (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.01-1.72), endoscopy performed by an endoscopist without prior PG experience (OR, 0.19; 95% CI, 0.11-0.36), and a longer duration after surgery (OR, 1.33; 95% CI, 1.02-1.72).

Conclusions: Understanding the anatomical changes after PG with DTR is essential for successful surveillance endoscopy. In addition, the failure rates across all serial endoscopies are very low. Therefore, clinicians should ensure sufficient procedure time during endoscopy, regardless of the outcomes of previous examinations.

This corrects the article on p. 115 in vol. 25, PMID: 39822171.

Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication.

Materials and methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis. Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis.

Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis. However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period.

Conclusions: Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient's circumstances.

Purpose: The present study investigated the impact of lifestyle behaviors and body mass index (BMI) on late recurrence, gastric remnant cancer (GRC), and long-term survival after curative gastrectomy.

Materials and methods: This retrospective study utilized data from the Korean National Health Insurance claims database. Among 71,014 patients with gastric cancer who underwent curative gastrectomy between January 2009 and December 2012, 23,359 remained cancer-free for five years. Of these, 7,735 patients with health examination data within 2 years before surgery and 5 years after surgery were analyzed for lifestyle behaviors, including smoking, alcohol consumption, and physical activity. Multivariable analysis was used to evaluate the independent effects of these factors and changes in BMI on late recurrence, GRC, and long-term survival.

Results: Late recurrence or GRC occurred among 628 patients (8.1%). Older age (≥60 years) and total gastrectomy were identified as risk factors. Although lifestyle behaviors and BMI changes did not directly affect recurrence, they significantly affected mortality. In the total gastrectomy group, current underweight status (hazard ratio [HR], 1.586) was associated with increased mortality. Among the partial gastrectomy group, continued smoking (HR, 1.366) and current underweight status (HR, 1.915) increased mortality risk. Conversely, regular physical activity (starting: HR, 0.674; continuing: HR, 0.699) and postoperative overweight or obesity (BMI >25 kg/m²) (HR, 0.713) were associated with reduced mortality. Changes in alcohol consumption showed inconsistent effects between the partial and total gastrectomy groups.

Conclusions: The long-term survival of post-gastrectomy patients improved with smoking cessation, regular physical activity, and maintenance of body weight.

Purpose: The novel curability criteria for elderly (EL) patients have been proposed to stratify their risk of lymph node metastasis (LNM), following non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Hence, this study aimed to evaluate the effectiveness of the EL criteria and compare them with those of the well-known eCura system.

Materials and methods: A retrospective analysis was performed on 143 patients who did not meet the curative ESD criteria at a tertiary hospital in Korea between 2011 and 2022. Of these, 102 underwent additional surgery, while 41 were followed up without further treatment. The LNM rates based on the EL and eCura systems were stratified and compared.

Results: In the surgery group, 29.4% (30/102) patients were classified as EL-low (EL-L) and 70.2% (72/102) as EL-high (EL-H). The LNM rates (95% confidence interval) were 0.0% (0.0-11.6) and 9.7% (4.0-19.0) for EL-L and EL-H, respectively (P=0.102). EL-L was closely aligned with the eCura low-risk category, with a similar patient proportion (32.4%) and an LNM rate of 0.0% (0.0-10.6). The eCura system classified 94.1% (48/51) of the EL-L patients as low-risk, with an 86% concordance rate (123/143). Discordant cases included patients with positive vertical margins, but without other risk factors, who were classified as EL-H without LNM.

Conclusions: Patients with EL-L showed no LNM, and the EL criteria demonstrated high concordance with the eCura system. The EL criteria may be as effective as the eCura system in identifying low-risk patients after non-curative ESD for EGC.