Remnant Gastric Cancer After Endoscopic Resection Failure: When ESD or EMR Did Not Achieve Adequate Clearance
This protocol addresses remnant gastric cancer in patients where an initial attempt at endoscopic resection — endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) — did not meet the criteria for an oncologically adequate outcome. When the endoscopic approach is no longer sufficient, a defined surgical next step applies.
Endoscopic resection (ESD or EMR) of the early or superficial lesion in the remnant stomach did not achieve macroscopic complete resection, or the pathologic specimen revealed lymphovascular infiltration. Either finding indicates that endoscopic management alone is inadequate and that escalation is required.
The recommended next step is surgical resection of the entire remnant stomach with lymph node dissection. The specific technique and operative approach are outlined in the full protocol.
The primary objective is R0 resection — complete removal of the remnant gastric cancer with clear margins — which is a key prognostic determinant in this disease.
References
DOI: 10.3389/fonc.2024.1457564
The mainstay of treatment for RGC patients is radical surgical resection during the passing few years. It involves removing the entire remnant stomach with lymph node dissection; this is known as a completion total gastrectomy with lymph node dissection.
Gastrectomy was mostly performed as an open procedure (OG), but more recently, minimally invasive surgical (MIS) approaches have undergone widespread adoption, including laparoscopic-assisted gastrectomy (LAG) and robotic-assisted gastrectomy (RG).
R0 resection is an important prognostic factor in RGC, as well as conventional gastric cancer.
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