Commentary: Clinicopathological characteristics and clinical outcomes of remnant gastric cancer with endoscopic submucosal dissection

Hui Liang¹Yong Guo^2*

• ¹Zhejiang Chinese Medical University First Clinical Medical College, Hangzhou, China
• ²Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China

We read with great interest the article entitled "Clinicopathological characteristics and clinical outcomes of remnant gastric cancer with endoscopic submucosal dissection" by et al. (1), The study provides a valuable contribution to the field by focusing on the application of endoscopic submucosal dissection (ESD) for remnant gastric cancer (RGC), a clinically challenging entity due to its rarity and technical complexity. The authors should be commended for their work.The primary strengths of this study lie in its detailed analysis of a well-characterized, albeit relatively small, single-center cohort of RGC patients treated with ESD over an 11-year period. The authors provide a comprehensive overview of the clinicopathological characteristics of RGC, which is informative given the limited data available on this specific condition. The reported en bloc resection rate of 96.9% and a 5-year overall survival rate of 83.0% are highly encouraging and strongly support their conclusion that ESD is a safe and feasible treatment option in experienced hands. Furthermore, the technical insights offered, particularly regarding the management of surgical staples and fibrotic tissue at anastomotic sites, are practical and add significant value for fellow endoscopists who may undertake similar procedures. The discussion thoughtfully contextualizes the findings within the existing literature and raises important points about the potential for expanding ESD indications in this unique patient population.While the study provides important insights, there may be opportunities to build upon this valuable work in future research. The retrospective, single-center design and the small sample size of 30 patients inevitably introduce the potential for selection bias and limit the generalizability of the findings. The fact that all procedures were performed by a single highly experienced endoscopist, while explaining the excellent outcomes, also means that these results may not be easily replicable in centers with less specialized expertise. The inclusion of a notable proportion of lesions outside standard indications, while clinically relevant, complicates the interpretation of outcomes, as the lower curative resection rate in this subgroup highlights the associated risks. Finally, the survival analysis is somewhat confounded by non-cancer-related deaths, and a comparison with a surgical control group or with ESD outcomes in primary gastric cancer would have strengthened the argument for ESD's role in managing RGC (2,3).In summary, this manuscript presents important real-world data that underscores the potential of ESD as a curative-intent treatment for carefully selected cases of RGC. The authors have successfully highlighted both the achievements and the challenges in this domain. Future prospective, multi-institutional studies with larger cohorts are needed to validate these findings and to better define the optimal indications and limitations of ESD for this complex disease.