Purpose: We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy. Materials and Methods: This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020.Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories. Results: After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows:anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7–14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively. Conclusions The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development.The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.

Purpose: Most studies have investigated the differences in postgastrectomy quality of life (QOL) based on the surgical procedure or reconstruction method adopted; only a few studies have compared QOL based on tumor location. This large-scale study aims to investigate the differences in QOL between patients with esophagogastric junction cancer (EGJC) and those with upper third gastric cancer (UGC) undergoing the same gastrectomy procedure to evaluate the impact of tumor location on postoperative QOL. Methods: The Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire was distributed in 70 institutions to 2,364 patients who underwent gastrectomy for EGJC or UGC.A total of 1,909 patients were eligible for the study, and 1,744 patients who underwent total gastrectomy (TG) or proximal gastrectomy (PG) were selected for the final analysis. These patients were divided into EGJC and UGC groups; thereafter, the PGSAS-45 main outcome measures (MOMs) were compared between the two groups for each type of gastrectomy. Results: Among the post-TG patients, only one MOM was significantly better in the UGC group than in the EGJC group. Conversely, among the post-PG patients, postoperative QOL was significantly better in 6 out of 19 MOMs in the UGC group than in the EGJC group. Conclusions Tumor location had a minimal effect on the postoperative QOL of post-TG patients, whereas among post-PG patients, there were definite differences in postoperative QOL between the two groups. It seems reasonable to conservatively estimate the benefits of PG in patients with EGJC compared to those in patients with UGC.

BACKGROUND/AIMS: The presence of invasion is a diagnostic criterion of early gastric cancer (EGC) in Korea, whereas diagnosis in Japan is based on enlarged nuclei and prominent nucleoli. Moreover, the depth of invasion is the location of cancer cell infiltration in Korea, whereas it is the location of lymphovascular invasion (LVI) or cancer cell infiltration in Japan. We evaluated the characteristics of EGC with LVI to uncover the effects of different diagnostic criteria. METHODS: Consecutive T1-stage EGC patients who underwent complete resection were included after endoscopic or surgical resection. The presence of LVI was evaluated. RESULTS: LVI was present in 112 of 1,089 T1-stage EGC patients. LVI was associated with depth of invasion (p<0.001) and age (p=0.017). The prevalence of LVI in mucosal cancer was significantly higher in Korea (p<0.001), whereas that of submucosal cancer was higher in Japan (p=0.024). For mucosal EGC types, LVI was positively correlated with diagnostic criteria applied in Korea (p=0.017). For submucosal EGC types, LVI was positively correlated with Japanese criteria (p=0.001) and old age (p=0.045). CONCLUSIONS: The higher prevalence of LVI for mucosal EGC in Korea and for submucosal EGC in Japan indicates that different diagnostic criteria should be considered when reading publications from other countries.
Asian Continental Ancestry Group ; Diagnosis ; Humans ; Japan* ; Korea* ; Prevalence* ; Stomach Neoplasms*