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Background: The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial., Aim: To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD., Methods: We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January 2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients' clinicopathological data and identified the predictors of residual cancer (RC) and lymph node metastasis (LNM)., Results: Surgical specimens showed RC in ten (22.2%) patients and LNM in five (11.1%). Multivariate analysis revealed that positive horizontal margin [odds ratio (OR) = 13.393, 95% confidence interval (CI): 1.435-125, P = 0.023] and neural invasion (OR = 14.714, 95%CI: 1.087-199, P = 0.043) were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM (OR = 12.000, 95%CI: 1.197-120, P = 0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 µm. Postoperative complications after additional laparoscopic gastrectomy occurred in five (11.1%) patients, and no deaths occurred among patients with complications., Conclusion: Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

We herein report a case of neuroendocrine carcinoma of the gastric stump found 47 years after Billroth II gastric resection for a benign gastric ulcer. A 74-year-old man was referred to another hospital with melena. Endoscopic examination revealed a localized ulcerative lesion at the gastrojejunal anastomosis. The diagnosis by endoscopic biopsy was neuroendocrine carcinoma. A total gastrectomy of the remnant stomach with D2 lymphadenectomy was performed at our hospital. The lesion invaded the subserosa, and metastasis was found in two of nine the lymph nodes retrieved. The lesion was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 60%. The diagnosis of neuroendocrine carcinoma of the gastric stump was confirmed using World Health Organization 2010 criteria. Subsequently, the patient underwent one course of adjuvant chemotherapy with the etoposide plus cisplatin (EP) regimen; however, treatment was discontinued due to grade 3 myelosuppression. The patient showed lymph node metastasis in the region around the gastrojejunal anastomosis in the abdominal cavity 7 mo post-surgery. He then underwent radiotherapy and platinum-based combination chemotherapy; however, the disease progressed and liver recurrence was observed on follow-up computed tomography at 16 mo post-surgery. The patient then received chemotherapy with regimens used for the treatment of small cell lung cancer in first- and second-line settings. The patient died of disease progression 31 months after surgery., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Objective: To investigate the risk factors and surgical treatment of recurrent gastrointestinal stromal tumors in the rectum., Methods: The clinical data of 24 cases,admitted to our hospital, were analyzed retrospectively. The possible risk factors were tested by chi(2)-test. The resectable rate and recurrent rate of recurrent cases were compared with the first-treated cases., Results: The tumors with biggest diameter >or=3 cm and high invasive risk had higher recurrent rates (chi(2)=4.874, P=0.027, chi(2)=6.659, P=0.010). The resectable rate of recurrent gastrointestinal stromal tumors in rectum was 64.3% (9/14), which was significantly lower than that of first-treated ones (23/24) (chi(2)=6.618, P=0.010). There was no significant difference of recurrent rate between the recurrent group and the first-treated group (chi(2)=1.459, P>0.05)., Conclusions: The size and invasive risk of tumor are associated with the recurrent rate of gastrointestinal stromal tumors in rectum. The resectable rate of recurrent gastrointestinal stromal tumors in rectum is significantly lower than that of first-treated ones, but recurrent rates are similar in the 2 groups.