Endoscopic submucosal dissection (ESD) is increasingly used to treat gastric dysplasia and early neoplasia in the West. Unlike Eastern countries, data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.

To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.

Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023. The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence, which include en-bloc and curative resection (CR) rates, local recurrence and survival rates.

ESD was attempted on 111 lesions in 93 patients. 95.0% of completed procedures achieved endoscopic clearance. 74.3% were en-bloc resections and the rest were hybrid ESD with piecemeal resections. In all, 34.7% achieved histological CR. Overall, disease recurrence was 10.9% at latest follow-up (63 months, median follow-up). Importantly 100% of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up. In the Indeterminate and Non-CR group, 18.8% of lesions showed disease recurrence at subsequent endoscopic follow-ups. ESD changed the histological staging of 44.5% of lesions. Immediate complications were observed in 9.9% of all ESD procedures. The median survival time was 69 months post-ESD. The mean age at death is 82.2 years old.

The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.

• Endoscopic resection
• Endoscopic submucosal dissection
• Gastric dysplasia
• Early gastric cancer
• Caucasian patients

• gastric cancer
• gastrointestinal cancer

• Adult
• Aged
• Aged, 80 and over
• Antigens, Tumor-Associated, Carbohydrate/analysis
• Decision Support Techniques
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Grading
• Nomograms
• Predictive Value of Tests
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stomach Neoplasms/immunology
• Stomach Neoplasms/pathology
• Tumor Burden
• Young Adult

• grant No.82001672 National Natural Science Foundation of China
• Y-2019Roche-157 Chinese Society of Clinical Oncology Roche foundation grants

In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.

• Digestive tract reconstruction
• Laparoscopic gastrectomy
• Gastric cancer
• Quality of life

• Billroth-Ⅰ
• Celiac branch preservation
• Laparoscopy-assisted distal gastrectomy
• Postoperative quality of life
• Reconstruction

Distant metastasis of early gastric cancer is a rare subgroup and poorly understood. The present study is aimed at summarizing the clinicopathological characteristics, prognosis, and management of clinical T1N0M1 (cT1N0M1) gastric cancer.

Between 2004 and 2015, patients diagnosed with cT1N0M1 gastric cancer were retrospectively analyzed using the Surveillance, Epidemiology, and End Results (SEER) database.

A total of 1093 cT1N0M1 gastric cancer patients were identified. 49 patients (4.5%) received cancer-directed surgery, and 113 patients (10.4%) were managed with radiotherapy. Compared with the other stage IV diseases, a relatively high proportion of black population (19.9% vs. 15.8%), patients older than 60 years (63.1% vs. 57.8%), and adenocarcinoma (59.5% vs. 55.9%) were observed in the cT1N0M1 gastric cancer subgroup. Besides that, patients with cT1N0M1 had the characteristics of less poor differentiated or undifferentiated (54.3% vs. 61.7%). Patients with cT1N0M1 had worse cancer-specific survival (CSS) and overall survival (OS) as compared to the other metastatic gastric cancer patients (CSS: p = 0.002, OS: p = 0.001 for log-rank test). Intriguingly, patients with cT1N0M1 had poor prognosis as compared to patients with cT1N+M1 (CSS: p = 0.015, OS: p = 0.007 for log-rank test). The 3-year and 5-year CSS for patients with cT1N0M1 were 5.7% and 4.0%, respectively. The addition of surgery resulted in improved CSS (p < 0.001 for log-rank test) while radiotherapy was not associated with CSS (p = 0.756 for log-rank test) in patients with cT1N0M1. A multivariate Cox analysis showed that surgery (HR = 0.378, 95% CI: 0.255-0.562) and patients younger than 60 (HR = 0.745, 95% CI: 0.647-0.858) years were independent protective factors for these subgroup patients.

Patients with cT1N0M1 gastric cancer had distinctive clinicopathological characteristics and presented poor prognosis. Knowledge of these differences contributes to guiding clinical evaluation for metastatic gastric cancer patients. More aggressive therapeutic strategy should be highlighted for this subgroup.

High expression of the RNA-binding motif protein 3 (RBM3) has previously been described as a favorable clinicopathological factor in several cancers, including ovarian cancer, colorectal cancer, prostate cancer, and breast cancer. The aim of this study was to examine the prognostic implications of RBM3 expression in gastric cancer.

Immunohistochemical analysis of RBM3 expression from 123 patients showed that upregulated RBM3 was mainly found in intestinal-type (n=78, case=59) cancer compared to diffuse-type (n=15, case=8) and mixed-type (n=30, case=17). There were no significant differences in RBM3 expression in subgroups of clinicopathological parameters. RBM3 expression was strongly associated with p53 but not with Ki-67. Cox univariate analysis revealed that high RBM3 expression was closely associated with prolonged overall survival time (HR 0.504, 95% CI: 0.300–0.845, P=0.009). Multivariate analysis remained supporting these associations when adjusted for age, sex, tumor size, differentiation grade, TNM stage, lymphatic invasion, and Ki-67 and p53 expression (HR 0.541, 95% CI: 0.308–0.952, P=0.033), where Lauren grade was not included. Lauren grade was the only factor with independent prognostic significance in a model adjusted for all factors. These results were confirmed by Kaplan-Meier analysis.

Therefore, together with the upregulated RBM3 expression observed in intestinal-type of Lauren grade, we suggest that upregulation of RBM3 is partially responsible for the favorable overall survival in cases with intestinal Lauren grade, which is demonstrated by the box diagram and Kaplan-Meier analysis. Our results showed that high RBM3 expression in gastric cancer is mainly found in intestinal-type of Lauren grade and is associated with longer overall survival time.

We found that RBM3 is a potential biomarker of good prognosis and deserves further validation.

• clinical outcomes
• early gastric cancer
• laparoscopy-assisted distal gastrectomy
• meta-analysis
• open distal gastrectomy

• Gastrectomy/methods
• Gastroenterostomy
• Humans
• Laparoscopy
• Neoplasm Staging
• Randomized Controlled Trials as Topic
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors
• Treatment Outcome

• R01 AG036042 NIA NIH HHS

• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Outcome Assessment, Health Care/methods
• Outcome Assessment, Health Care/statistics & numerical data
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Proportional Hazards Models
• Reproducibility of Results
• Sensitivity and Specificity
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/surgery
• Survival Analysis