J Gastric Cancer.  2017 Mar;17(1):33-42. 10.5230/jgc.2017.17.e4.

The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

Affiliations
  • 1Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 2Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea. docryu@ncc.re.kr

Abstract

PURPOSE
Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors.
MATERIALS AND METHODS
From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD.
RESULTS
Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications.
CONCLUSIONS
ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

Keyword

Complications; Endoscopic submucosal dissection; Gastrectomy; Laparoscopy

MeSH Terms

Gastrectomy*
Humans
Inflammation
Laparoscopy
Length of Stay
Lymph Node Excision
Male
Multivariate Analysis
Postoperative Complications
Retrospective Studies
Risk Factors
Stomach Neoplasms*
Stomach Ulcer

Cited by  1 articles

Current Status of Endoscopic Resection of Early Gastric Cancer in Korea
Hwoon-Yong Jung
Korean J Gastroenterol. 2017;70(3):121-127.    doi: 10.4166/kjg.2017.70.3.121.


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