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

• Lee EG
• Ryu KW
• Eom BW
• Yoon HM
• Kim YI
• Cho SJ
• Lee JY
• Kim CG
• Choi IJ
• Kim YW

• KMID: 2372580
• DOI: http://doi.org/10.5230/jgc.2017.17.e4

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

Reference

1. Oh CM, Won YJ, Jung KW, Kong HJ, Cho H, Lee JK, Community of Population-Based Regional Cancer Registries, et al. Cancer Statistics in Korea: incidence, mortality, survival, and prevalence in 2013. Cancer Res Treat. 2016; 48:436–450. PMID: 26987395.

2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123. PMID: 21573742.

3. Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ, et al. Clinical practice guidelines for gastric cancer in Korea: an evidence-based approach. J Gastric Cancer. 2014; 14:87–104. PMID: 25061536.

4. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007; 10:1–11. PMID: 17334711.

5. Park YM, Cho E, Kang HY, Kim JM. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc. 2011; 25:2666–2677. PMID: 21424201.

6. Son SY, Park JY, Ryu KW, Eom BW, Yoon HM, Cho SJ, et al. The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: is the minimal lymph node dissection applicable? A retrospective study. Surg Endosc. 2013; 27:3247–3253. PMID: 23508816.

7. Eom BW, Kim YI, Kim KH, Yoon HM, Cho SJ, Lee JY, et al. Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer. Gastrointest Endosc. 2017; 85:155–163. PMID: 27460389.

8. Akagi T, Shiraishi N, Hiroishi K, Etoh T, Yasuda K, Kitano S. Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy. Gastrointest Endosc. 2010; 72:438–443. PMID: 20541190.

9. Lee HH, Lim CH, Park JM, Cho YK, Song KY, Jeon HM, et al. Low accuracy of endoscopic ultrasonography for detailed T staging in gastric cancer. World J Surg Oncol. 2012; 10:190. PMID: 22978534.

10. Hamilton SR, Aaltonen LA, editors. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press;2000.

11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213. PMID: 15273542.

12. Suzuki T, Tanabe K, Vu DT, Misumi T, Fujikuni N, Tokumoto N, et al. Safety and efficacy of laparoscopy-assisted gastrectomy after endoscopic submucosal dissection for early gastric cancer: a retrospective report. J Cancer Ther. 2013; 4:54–60.

13. Park CH, Lee H, Kim DW, Chung H, Park JC, Shin SK, et al. Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc. 2014; 80:599–609. PMID: 24973177.

14. Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011; 74:485–493. PMID: 21741645.

15. Kwon HY, Hyung WJ, Lee JH, Lee SK, Noh SH. Outcomes of laparoscopic gastrectomy after endoscopic treatment for gastric cancer: a comparison with open gastrectomy. J Gastric Cancer. 2013; 13:51–57. PMID: 23610719.

16. Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K. Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer. 2000; 3:141–144. PMID: 11984727.

17. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995; 345:745–748. PMID: 7891484.

18. Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, et al. Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol. 2009; 100:392–395. PMID: 19598150.

19. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group, et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol. 2008; 15:2692–2700. PMID: 18663532.

20. Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK. Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc. 2012; 26:3418–3425. PMID: 22648120.