J Minim Invasive Surg.  2016 Mar;19(1):14-18. 10.7602/jmis.2016.19.1.14.

Impact of the Endoscopic Submucosal Dissection on Early Postoperative Outcome after Additional Gastric Resections for Early Gastric Cancer

• Kim JS
• Cho HR
• Yang SS
• Im YC
• Kim GY

• KMID: 2159101
• DOI: http://doi.org/10.7602/jmis.2016.19.1.14

Abstract

PURPOSE
The aim of this study was to compare ESD only and subsequent Laparoscopy-assisted gastrectomy (LAG) patients for EGC through propensity score matching analysis.
METHODS
This study was a retrospective review of the records of 46 consecutive patients with gastric cancer who underwent LAG after ESD from 2009, September to 2014, September, and propensity matching analysis was performed with 92 patients who underwent LAG without ESD as a control group. Subgroup analysis was performed with the interval of subsequent laparoscopic gastrectomy and endoscopic resection (within 2 weeks, 2~4 weeks, above 4 weeks).
RESULTS
There were no significant differences in age, gender, body mass index, comorbidity, previous abdominal surgery, and location of the lesion or clinical stage between the two groups. Early postoperative outcomes including postoperative complications and postoperative hospital stay were not significantly different between the two groups. According to subgroup analysis with the interval of laparoscopic gastrectomy and endoscopic resection, there were no significant differences in early outcomes in three groups. However, only early postoperative complication rate was significantly higher in patients who received LAG more than 4 weeks after ESD (0 versus 4.76 versus 40 per cent; p=0.0032).
CONCLUSION
We analyzed the influence of ESD on subsequent LAG using propensity score matching to reduce the bias. However, we found that ESD might induce inflammation for a significant duration, but ESD had little influence on early postoperative outcome of LAG.

Keyword

Early gastric cancer; Subsequent laparoscopic gastrectomy; Endoscopic submucosal dissection; Propensity score matching analysis

MeSH Terms

Bias (Epidemiology)
Body Mass Index
Comorbidity
Gastrectomy
Humans
Inflammation
Length of Stay
Postoperative Complications
Propensity Score
Retrospective Studies
Stomach Neoplasms*