ABSTRACT
Background
Remnant gastric cancer (RGC) is an entity for which completion gastrectomy (CG) is considered the standard treatment. However, subtotal resection of the remnant stomach (SR) may preserve postoperative nutritional status while maintaining oncologic safety. Comparative data between these two procedures in RGC remain limited.
Methods
A retrospective multicenter cohort study was conducted involving 133 patients who underwent surgery for RGC at five institutions. Patients were categorized into SR (n = 17) and CG (n = 116) groups, and perioperative characteristics, postoperative outcomes, and long‐term survival were compared.
Results
Operative time was significantly shorter in the SR group than in the CG group (236.4 vs. 317.3 min; p = 0.001). There were no significant differences in lymph node dissection, resection margins, or overall postoperative complication rates between the groups. The postoperative body weight loss rate was significantly lower in the SR group compared with the CG group (5.02% vs. 9.96%; p = 0.016). Overall survival and recurrence‐free survival did not differ significantly between the groups.
Conclusions
Subtotal gastrectomy for RGC was associated with reduced operative time and minimized postoperative weight loss without compromising oncologic safety. These findings suggest that SR may be a feasible alternative to CG in selected patients with RGC.
Keywords: body weight loss, completion gastrectomy, prognosis, remnant gastric cancer, subtotal gastrectomy
This multicenter study compared subtotal versus completion gastrectomy for remnant gastric cancer. Subtotal gastrectomy was associated with shorter operative time and significantly less postoperative weight loss, with no difference in long‐term survival, suggesting it as a feasible surgical option without compromising oncologic outcomes.
1. Introduction
Gastric cancer is the fifth most common malignancy and the third leading cause of cancer‐related mortality worldwide, with an estimated 12.7 million new cancer cases and 7.6 million cancer‐related deaths annually [1, 2]. Remnant gastric cancer (RGC) is defined as gastric cancer that arises in the residual stomach following gastrectomy for benign or malignant disease. Previous reports have shown that the incidence of RGC was approximately 2%–3% [3]. Radical gastrectomy remains the standard curative treatment for RGC [4], and completion gastrectomy with lymph node dissection is typically performed. However, total gastrectomy has several disadvantages, particularly concerning postoperative nutritional status, including significant body weight loss [5, 6, 7].
Several studies have investigated subtotal gastrectomy (sTG) for primary gastric cancer. Although consistent results regarding oncologic safety have not been obtained—especially concerning postoperative survival analyses—no reports have indicated that sTG is inferior to total gastrectomy (TG) in terms of survival. Two studies reported no significant differences in prognosis between sTG and TG [8, 9], while two others even suggested superior outcomes with sTG [10, 11]. Regarding surgical factors, meta‐analyses have demonstrated that operative time is significantly shorter with sTG compared to TG [12, 13].
Similarly, regarding postoperative complications, meta‐analyses revealed that the incidence of Clavien–Dindo grade ≥ 2 and grade ≥ 3 complications was significantly lower in patients who underwent sTG [8, 9, 10, 11, 12, 13, 14, 15, 16]. However, there were no significant differences in anastomosis‐related complications, including leakage or stenosis, depending on the type of surgical procedure [9, 10, 11, 14].
Postgastrectomy symptoms, including dumping syndrome, anemia, delayed gastric emptying, and reflux esophagitis, were reported to be less frequent after sTG compared to TG [10, 16], and a meta‐analysis also demonstrated the superiority of sTG in reducing reflux esophagitis [8, 9, 10, 11, 12, 13]. Furthermore, nutritional status, assessed by weight loss, was significantly better preserved in sTG cases [9, 10, 11, 12].
Meanwhile, a few studies have examined sTG for RGC. Irino et al. reported that sTG could be a feasible treatment option for early‐stage RGC, although nutritional outcomes and long‐term survival were not evaluated [17]. Goto et al. compared subtotal resection of the remnant stomach (SR) and completion gastrectomy (CG) for clinical stage I RGC in 43 patients and showed that postoperative weight loss, body mass index (BMI) reduction, and serum albumin decrease were all significantly less pronounced in the SR group [18]. Nevertheless, research on SR for RGC remains limited to small, single‐center studies.
Therefore, the present study aimed to evaluate the short‐ and long‐term outcomes of SR versus CG for RGC, using a multi‐institutional database comprising cases from five facilities.
2. Methods
2.1. Patients
In this retrospective multicenter cohort study, data were collected from five institutions: Kyushu University, Kyushu Cancer Center, Kyushu Medical Center, Iizuka Hospital, and Kyushu Central Hospital. Patients who underwent surgery for RGC between October 2013 and October 2024 at four institutions (excluding Kyushu University) and between July 2007 and October 2022 at Kyushu University were included. A total of 135 patients were initially identified. After excluding two patients who underwent simultaneous surgery for synchronous other cancers, 133 patients were included in the final analysis.
Short‐term outcomes were assessed in all consecutive surgical cases. Long‐term outcomes were analyzed only in patients who achieved curative resection; therefore, patients with pathological Stage IV disease were excluded because their prognosis is markedly influenced by uncertain curability.
SR was considered when the tumor was confined to the distal portion of the remnant stomach, when an adequate proximal margin (> 2 cm) could be secured, and when no diffuse infiltration or serosal invasion of the proximal remnant stomach was suspected based on preoperative imaging or intraoperative findings.
Residual tumor was classified according to the R‐classification. R0 resection was defined as the absence of microscopic tumor involvement at any resection margin. A minimum margin of 0 mm represented a microscopically negative (R0) margin abutting, but not infiltrated by, the tumor. R1 resection included microscopic margin involvement (PM+ or DM+) as well as residual tumor resulting from positive peritoneal cytology (CY1) or peritoneal dissemination (P1).
This study was approved by the Institutional Review Board of Kyushu University (approval number 24156‐00) and conducted in accordance with the Declaration of Helsinki (revised in Fortaleza, Brazil, October 2013), available at https://www.wma.net/what‐we‐do/medical‐ethics/declaration‐of‐helsinki/. Informed consent was obtained from all patients. For patients from whom direct consent could not be obtained, an opt out procedure was employed via the study website.
2.2. Clinical Outcomes
Postoperative body weight was evaluated at approximately 6 months after surgery. Weight loss was expressed as the percentage change relative to the preoperative body weight. Short‐term outcomes included operative time, blood loss, surgical complications, and length of hospital stay. Long‐term outcomes included overall survival (OS) and recurrence‐free survival (RFS).
2.3. Statistical Analyses
Differences in characteristics between the groups were evaluated by using Fisher's exact test or the unpaired t‐test. Survival curves were plotted using the Kaplan–Meier method. Differences were analyzed using the log‐rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model to identify independent predictive factors. All p‐values were two‐sided, with p < 0.05 being statistically significant. All statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface for R (R Foundation for Statistical Computing, Vienna, Austria) [19]. EZR is a modified version of R Commander, which is designed to add statistical functions frequently used in biostatistics.
3. Results
3.1. Clinical Features
Patients were divided into the SR group (n = 17) and the CG group (n = 116) based on the surgical procedure. Clinical characteristics of each group are summarized in Table 1. The mean age was slightly higher in the SR group (75.2 years) than in the CG group (71.5 years), but the difference was not statistically significant (p = 0.107). There were no significant differences between groups in BMI, serum albumin levels, or tumor‐node‐metastasis (TNM) stage distribution. In the SR group, 13 patients (76.5%) underwent initial gastrectomy for benign disease and 4 patients (23.5%) for malignant disease, whereas 50 patients (43.1%) underwent initial gastrectomy for benign disease and 65 patients (56.0%) for malignant disease in the CG group.
TABLE 1.
Baseline demographic and clinical characteristics of patients who underwent subtotal resection of the remnant stomach or completion gastrectomy for remnant gastric cancer.
| Factor | SR (n = 17), n (%) | CG (n = 116), n (%) | p | |
|---|---|---|---|---|
| Sex | Male | 17 (100.0) | 88 (75.9) | 0.023 |
| Female | 0 (0.0) | 28 (24.1) | ||
| Age in years | Mean (range) | 75.2 (67–87) | 71.5 (47–92) | 0.107 |
| BMI | Mean (range) | 20.5 (15.3–26.1) | 20.9 (14.2–30.4) | 0.640 |
| Clinical stage | I | 8 (47.1) | 74 (63.8) | 0.383 |
| II | 7 (41.2) | 29 (25.0) | ||
| III | 1 (5.9) | 7 (6.0) | ||
| IV | 1 (5.9) | 6 (5.2) | ||
| Hb (g/dL) | Mean (range) | 11.2 (8.5–14.3) | 11.9 (7.1–16.3) | 0.153 |
| Alb (g/dL) | Mean (range) | 3.6 (2.1–4.5) | 3.8 (2.2–4.7) | 0.076 |
| CRP (mg/dL) | Mean (range) | 0.74 (0.03–5.33) | 0.45 (0.01–7.82) | 0.372 |
| CEA (ng/mL) | Mean (range) | 4.0 (0.6–12.0) | 4.4 (0.6–47.2) | 0.825 |
| CA19‐9 (U/mL) | Mean (range) | 12.4 (2.0–41.9) | 88.5 (0.0–5971) | 0.599 |
| Primary disease at initial gastrectomy | Benign | 13 (76.5) | 50 (43.1) | 0.029 |
| Malignant | 4 (23.5) | 65 (56.0) | ||
| Unknown | 0 (0.0) | 1 (0.9) | ||
| Preoperative chemotherapy | None | 17 (100.0) | 115 (99.1) | 1.000 |
| Yes | 0 (0.0) | 1 (0.9) | ||
| Type of initial gastrectomy | Distal gastrectomy | 15 (88.2) | 108 (93.1) | 0.117 |
| Proximal gastrectomy | 0 (0.0) | 6 (5.2) | ||
| Pancreaticoduodenectomy | 1 (5.9) | 2 (1.7) | ||
| Pathological stage | I | 8 (47.1) | 60 (51.7) | 0.435 |
| II | 6 (35.3) | 35 (30.2) | ||
| III | 1 (5.9) | 16 (13.8) | ||
| IV | 2 (11.8) | 5 (4.3) |
Note: Data are presented as mean (range) or number (%) unless otherwise indicated. Tumor staging was performed according to the 15th edition of the Japanese Classification of Gastric Carcinoma.
Abbreviations: Alb, albumin; BMI, body mass index; CA19‐9, carbohydrate antigen 19‐9; CEA, carcinoembryonic antigen; CG, completion gastrectomy; CRP, C‐reactive protein; Hb, Hemoglobin; SR, subtotal resection of the remnant stomach.
3.2. Operative Outcomes
Operative outcomes are presented in Table 2. The operative time was significantly shorter in the SR group than in the CG group (SR: 236.4 min vs. CG: 317.3 min, p = 0.001). No significant differences were observed between the groups regarding the number of lymph nodes dissected or the proximal and distal resection margins. The overall postoperative complication rates were comparable between the groups (SR: 35.3% vs. CG: 32.8%). Notably, pancreatic fistula (6.9%) and bleeding (5.2%) occurred in the CG group, while neither was observed in the SR group. Anastomotic leakage occurred in one case (0.9%) in the CG group. Splenectomy was performed in five patients in the CG group and in none of the SR group; among the splenectomy cases, one patient (20%) developed pancreatic fistula (Table 2).
TABLE 2.
Operative factors and outcomes in patients who underwent subtotal resection of the remnant stomach or completion gastrectomy for remnant gastric cancer.
| Factor | SR (n = 17), n (%) | CG (n = 116), n (%) | p | |
|---|---|---|---|---|
| Surgical approach | Open | 15 (88.2) | 85 (73.3) | 0.239 |
| Laparoscopic | 2 (11.8) | 31 (26.7) | ||
| Splenectomy | None | 17 (100.0) | 111 (95.7) | 1.000 |
| Yes | 0 (0.0) | 5 (4.3) | ||
| Operative time (min) | Mean (range) | 236.4 (159–383) | 317.3 (156–657) | 0.001 |
| Intraoperative blood loss (mL) | Mean (range) | 248.1 (0–675) | 447.0 (0–2080) | 0.096 |
| Tumor size | Mean (range) | 43.7 (15–100) | 45.5 (4–160) | 0.383 |
| Location in remnant stomach | Gastric body | 11 (64.7) | 102 (87.9) | 0.020 |
| Anastomotic site | 6 (35.3) | 11 (9.5) | ||
| Cardia | 0 (0.0) | 3 (2.6) | ||
| Proximal margin (mm) | Mean (range) | 47.5 (5–100) | 46.3 (0–150) | 0.887 |
| Distal margin (mm) | Mean (range) | 61.3 (15–140) | 59.0 (0–310) | 0.851 |
| Number of dissected lymph nodes | Mean (range) | 15.1 (3–38) | 15.3 (0–74) | 0.955 |
| Number of metastatic lymph nodes | Mean (range) | 0.4 (0–3) | 1.5 (0–32) | 0.302 |
| Residual tumor | R0 | 16 (94.1) | 108 (93.1) | 1.000 |
| R1 | 1 (5.9) | 8 (6.9) | ||
| Postoperative complication | None | 11 (64.7) | 78 (67.2) | 1.000 |
| Yes | 6 (35.3) | 38 (32.8) | ||
| Clavien–Dindo grade | < 3a | 16 (94.1) | 96 (82.8) | 0.308 |
| ≥ 3a | 1 (5.9) | 20 (17.2) | ||
| Details of complication | Pancreatic fistula | 0 (0.0) | 8 (6.9) | 0.311 |
| Bleeding | 0 (0.0) | 6 (5.2) | ||
| Respiratory complication | 2 (11.8) | 4 (3.4) | ||
| Surgical site infection | 1 (5.9) | 4 (3.4) | ||
| Intra‐abdominal abscess | 0 (0.0) | 3 (2.6) | ||
| Ileus | 0 (0.0) | 3 (2.6) | ||
| Stenosis | 2 (11.8) | 2 (1.7) | ||
| Anastomotic leakage | 0 (0.0) | 1 (0.9) | ||
| Others | 1 (5.9) | 7 (6.0) | ||
| Hospital stays (days) | Mean (range) | 20.1 (8–78) | 19.6 (8–289) | 0.936 |
| 30‐day postoperative mortality | Survival | 17 (100.0) | 114 (98.3) | 1.000 |
| Death | 0 (0.0) | 2 (1.7) | ||
| Adjuvant chemotherapy | None | 14 (82.4) | 87 (75.0) | 0.801 |
| Yes | 3 (17.6) | 21 (18.1) | ||
| Unknown | 0 (0.0) | 8 (6.9) | ||
| Recurrence | None | 15 (88.2) | 89 (76.7) | 0.362 |
| Yes | 2 (11.8) | 27 (23.3) | ||
| Recurrence pattern | Peritoneal dissemination | 2 (11.8) | 12 (10.3) | |
| Lymph node | 0 (0.0) | 8 (6.9) | ||
| Liver | 0 (0.0) | 6 (5.2) | ||
| Lung | 0 (0.0) | 3 (2.6) | ||
| Local | 0 (0.0) | 1 (0.9) |
Note: Data are presented as the number (%) unless otherwise stated. Residual tumor was classified according to the R‐classification. A minimum margin of 0 mm indicates a microscopically negative (R0) margin abutting the resection edge. R1 included microscopic margin positivity (PM+ or DM+) or residual tumor due to positive peritoneal cytology (CY1) or peritoneal dissemination (P1).
Abbreviations: CG, completion gastrectomy; SR, subtotal resection of the remnant stomach.
Regarding residual tumor according to the R‐classification, one patient in the SR group and eight patients in the CG group had R1 resection. The R1 case in the SR group resulted from P1. Among the 8 R1 cases in the CG group, five were due to residual disease associated with CY1 or P1, and three were caused by microscopic proximal margin involvement (PM+). Among the cases with a recorded minimum margin of 0 mm, 3 corresponded to PM‐positive R1 resections, whereas the other 2 cases with 0‐mm margins were microscopically negative and thus classified as R0.
3.3. Comparison of Postoperative Body Weight Loss
Postoperative body weight change was evaluated in 13 patients in the SR group and 105 patients in the CG group. The SR group showed a significantly lower postoperative weight loss rate compared to the CG group (SR: 5.02% vs. CG: 9.96%, p = 0.016) (Figure 1).
FIGURE 1.
Comparison of the rate of postoperative weight loss in patients with remnant gastric cancer between the subtotal resection of the remnant stomach (SR) group and the completion gastrectomy (CG) group. CG, completion gastrectomy; SR, subtotal resection of the remnant stomach.
3.4. Long‐Term Outcomes
The prognostic analysis was conducted on 126 patients, excluding those with pathological stage IV disease. Kaplan–Meier survival analysis showed no significant difference in OS between the SR and CG groups (p = 0.518, Figure 2a). Similarly, no significant difference was observed in RFS (p = 0.663, Figure 2b). Univariate and multivariate analyses using the Cox proportional hazards model were performed to assess whether surgical procedure (SR vs. CG) was associated with prognosis. Neither analysis identified SR as an independent factor affecting OS or RFS (Tables 3 and 4). The number of patients and events for each categorical variable included in the Cox regression analyses are summarized in Table S1.
FIGURE 2.
Kaplan–Meier (a) overall survival and (b) recurrence‐free survival curves in patients with remnant gastric cancer based on the surgical procedure. CG, completion gastrectomy; OS, overall survival; RFS, recurrence‐free survival; SR, subtotal resection of the remnant stomach.
TABLE 3.
Univariate and multivariate analyses for overall survival.
| Factor | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|
| HR (95% CI) | p | HR (95% CI) | p | |
| Age ≥ 75 years (vs. < 75 years) | 1.862 (0.966–3.592) | 0.0636 | 1.504 (0.683–3.311) | 0.3105 |
| CEA > 5 ng/mL (vs. ≤ 5) | 1.443 (0.631–3.300) | 0.3850 | 1.027 (0.425–2.483) | 0.9526 |
| CA19‐9 > 37 U/mL (vs. ≤ 37) | 1.744 (0.674–4.511) | 0.2516 | 0.954 (0.326–2.791) | 0.9315 |
| pStage II–III (vs. I) | 3.112 (1.563–6.193) | 0.0012 | 3.036 (1.301–7.085) | 0.0102 |
| Open (vs. laparoscopic) | 1.193 (0.564–2.525) | 0.6444 | 1.157 (0.484–2.765) | 0.7428 |
| IBL ≥ 500 mL (vs. < 500) | 1.874 (0.940–3.736) | 0.0744 | 1.375 (0.568–3.333) | 0.4803 |
| PM < 20 mm (vs. ≥ 20) | 1.473 (0.742–3.255) | 0.2425 | 1.406 (0.632–3.128) | 0.4033 |
| SR (vs. CG) | 0.679 (0.208–2.212) | 0.5204 | 1.004 (0.285–3.535) | 0.9950 |
Abbreviations: CA19‐9, carbohydrate antigen 19‐9; CEA, carcinoembryonic antigen; CG, completion gastrectomy; CI, confidence interval; HR, hazard ratio; IBL, intraoperative blood loss; PM, proximal margin; SR, subtotal resection of the remnant stomach.
TABLE 4.
Univariate and multivariate analyses for recurrence‐free survival.
| Factor | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|
| HR (95% CI) | p | HR (95% CI) | p | |
| Age ≥ 75 years (vs. < 75 years) | 1.815 (0.971–3.391) | 0.0618 | 1.441 (0.692–3.002) | 0.3288 |
| CEA > 5 ng/mL (vs. ≤ 5) | 1.468 (0.674–3.195) | 0.3337 | 1.054 (0.463–2.401) | 0.9002 |
| CA19‐9 > 37 U/mL (vs. ≤ 37) | 1.973 (0.822–4.735) | 0.1283 | 1.099 (0.415–2.908) | 0.8498 |
| pStage II–III (vs. I) | 3.671 (1.864–7.231) | 0.0002 | 3.556 (1.540–8.209) | 0.0030 |
| Open (vs. laparoscopic) | 1.235 (0.589–2.590) | 0.5770 | 1.194 (0.511–2.788) | 0.6823 |
| IBL ≥ 500 mL (vs. < 500) | 1.996 (1.027–3.876) | 0.0414 | 1.345 (0.579–3.125) | 0.4913 |
| PM < 20 mm (vs. ≥ 20) | 1.717 (0.846–3.485) | 0.1344 | 1.484 (0.692–3.184) | 0.3106 |
| SR (vs. CG) | 0.795 (0.282–2.238) | 0.6635 | 1.108 (0.366–3.354) | 0.8555 |
Abbreviations: CA19‐9, carbohydrate antigen 19‐9; CEA, carcinoembryonic antigen; CG, completion gastrectomy; CI, confidence interval; HR, hazard ratio; IBL, intraoperative blood loss; PM, proximal margin; SR, subtotal resection of the remnant stomach.
4. Discussion
In this study, we compared short‐ and long‐term outcomes between SR and CG in patients with RGC. We found that SR was associated with shorter operative time and significantly less postoperative body weight loss compared to CG, while long‐term oncological outcomes were comparable between the two procedures. In primary gastric cancer, SR has been suggested to offer advantages over CG regarding operative time, postoperative complications, functional outcomes, and nutritional status [8, 9, 10, 11, 12, 13, 14, 15]. However, ensuring an appropriate surgical margin is crucial. Regarding RGC, evidence remains limited due to the small number of cases and reports. However, based on our findings, SR may also offer benefits in RGC, particularly in terms of surgical invasiveness and postoperative nutritional maintenance.
With respect to postoperative complications, pancreatic fistula occurred only in the CG group (6.9%). Splenectomy was performed in five patients, also exclusively in the CG group, and one of these patients developed pancreatic fistula. Although the number of splenectomy cases was too small to allow statistical evaluation, manipulation around the pancreatic tail during splenectomy may have contributed to the occurrence of fistula. Previous studies have also suggested that splenectomy increases the risk of pancreatic fistula due to the anatomical proximity of the pancreatic tail. Therefore, the higher fistula rate observed in the CG group may be partially attributable to splenectomy, although further investigation with larger cohorts is required.
Postoperative weight loss is regarded as a critical indicator of nutritional status and was significantly better preserved in the SR group both in our study and in the study by Goto et al. [18]. The possible reasons for this include preservation of the esophagogastric junction, which may reduce reflux symptoms and improve oral intake after surgery. Additionally, previous studies have shown that ghrelin, a hormone primarily secreted by the gastric fundus, plays an important role in appetite regulation [20, 21]. Preserving even a small portion of the fundus may help maintain appetite and thus postoperative body weight. Of course, adequate resection margins must be secured, and SR is not applicable to all cases, depending on tumor location, size, and stage. In our study, there were no significant differences in proximal or distal margins, and no differences in OS or RFS were observed between the two groups. However, similar to primary gastric cancer, appropriate case selection is essential for the safe application of SR in RGC.
Regarding recurrence, our analysis showed that the overall recurrence rate was 11.8% in the SR group and 23.3% in the CG group. Peritoneal dissemination was the most frequent recurrence pattern in both groups (SR: 11.8%, CG: 10.3%), followed by lymph node and liver recurrence. These findings suggest that peritoneal dissemination remains the predominant recurrence mode in RGC, similar to primary gastric cancer. We also examined the relationship between recurrence and adjuvant chemotherapy (Table S2). Recurrence was observed in 45.8% of patients who received adjuvant chemotherapy and in 30.3% of those who did not; however, this difference was not statistically significant. This likely reflects a selection bias, as higher‐risk patients were more likely to receive adjuvant chemotherapy. While our study could not establish a protective effect of adjuvant therapy, the results highlight the need for further investigation in larger, prospective cohorts to clarify its role in RGC.
This study has several limitations. Although data were collected from multiple institutions, the total number of RGC cases remained relatively small. Moreover, most patients underwent CG, and the number of SR cases was limited. Additionally, the retrospective design and variability in surgical indications make direct comparison challenging. In addition, postoperative nutritional status was evaluated primarily based on body weight loss, and other indicators such as biochemical parameters were not included. Nevertheless, our findings suggest that, with careful patient selection, SR may serve as a safe and beneficial surgical option for RGC.
5. Conclusions
This multicenter retrospective study demonstrated that SR for RGC is associated with shorter operative time and minimized postoperative weight loss, compared with CG. No significant differences in long‐term oncological outcomes were observed between the two surgical approaches. These results indicate that SR may be a safe and effective alternative to CG for appropriately selected patients. In particular, SR may be advantageous for patients with tumors located at the anastomotic site, those with early‐stage disease, and elderly patients with comorbidities, as it can reduce surgical invasiveness while maintaining oncological safety. Careful patient selection and meticulous margin assessment remain essential when considering SR as a treatment option for RGC.
Author Contributions
Kensuke Kudou: conceptualization, methodology, data curation, investigation, validation, formal analysis, funding acquisition, visualization, writing – original draft, writing – review and editing. Mitsuhiko Ota: data curation, supervision. Kippei Ogaki: data curation, supervision. Yasue Kimura: data curation, supervision. Yuta Kasagi: data curation. Naomichi Koga: data curation. Hirofumi Hasuda: data curation. Tetsuro Kawazoe: data curation. Eiji Oki: supervision. Tomoharu Yoshizumi: supervision.
Funding
This work was supported by grants to Dr. Kensuke Kudou from the Kaibara Morikazu Medical Science Promotion Foundation (Tokyo, Japan; 2019); Uehara Memorial Foundation (Tokyo, Japan; 2020); Clinical Research Promotion Foundation (Tokyo, Japan; 2020); and Fukuoka Public Health Promotion Organization Cancer Research Fund (Fukuoka, Japan; 2021).
Ethics Statement
This study was approved by the Institutional Review Board of Kyushu University (24156‐00). The study conformed to the provisions of the Declaration of Helsinki (revised in Fortaleza, Brazil, October 2013) available at https://www.wma.net/what‐we‐do/medical‐ethics/declaration‐of‐helsinki/.
Consent
Informed consent was obtained from all patients. For patients from whom direct consent could not be obtained, an opt out procedure was employed via the study website.
Conflicts of Interest
Dr. Kensuke Kudou was supported by grants from the Kaibara Morikazu Medical Science Promotion Foundation in 2019, the Uehara Memorial Foundation in 2020, the Clinical Research Promotion Foundation in 2020, and the Fukuoka Public Health Promotion Organization Cancer Research Fund in 2021. Dr. Yasue Kimura, Dr. Eiji Oki, and Dr. Tomoharu Yoshizumi are editorial board members of Annals of Gastroenterological Surgery. Drs. Mitsuhiko Ota, Kippei Ogaki, Yuta Kasagi, Naomichi Koga, Hirofumi Hasuda, and Tetsuro Kawazoe have no conflicts of interest or financial ties to disclose.
Supporting information
Table S1: Number of patients and events in each subgroup of categorical variables included in Cox regression analyses.
Table S2: Recurrence rates and recurrence patterns according to adjuvant chemotherapy.
Acknowledgments
We thank the Kaibara Morikazu Medical Science Promotion Foundation (Tokyo, Japan), Uehara Memorial Foundation (Tokyo, Japan), the Clinical Research Promotion Foundation (Tokyo, Japan), and the Fukuoka Public Health Promotion Organization Cancer Research Fund (Fukuoka, Japan) for providing financial support.
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Associated Data
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Supplementary Materials
Table S1: Number of patients and events in each subgroup of categorical variables included in Cox regression analyses.
Table S2: Recurrence rates and recurrence patterns according to adjuvant chemotherapy.