Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 25 (29), 3996-4006

Additional Laparoscopic Gastrectomy After Noncurative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Single-Center Experience

Affiliations

Additional Laparoscopic Gastrectomy After Noncurative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Single-Center Experience

Yan-Tao Tian et al. World J Gastroenterol.

Abstract

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.

Keywords: Early gastric cancer; Endoscopic submucosal dissection; Laparoscopic gastrectomy; Lymph node metastasis; Residual cancer.

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Similar articles

See all similar articles

References

    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. - PubMed
    1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–112. - PubMed
    1. Noh GY, Ku HR, Kim YJ, Park SC, Kim J, Han CJ, Kim YC, Yang KY. Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection. Surg Endosc. 2015;29:2583–2589. - PubMed
    1. Toyokawa T, Ohira M, Tanaka H, Minamino H, Sakurai K, Nagami Y, Kubo N, Yamamoto A, Sano K, Muguruma K, Tominaga K, Nebiki H, Yamashita Y, Arakawa T, Hirakawa K. Optimal management for patients not meeting the inclusion criteria after endoscopic submucosal dissection for gastric cancer. Surg Endosc. 2016;30:2404–2414. - PubMed
    1. Yoon H, Kim SG, Choi J, Im JP, Kim JS, Kim WH, Jung HC. Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer. Surg Endosc. 2013;27:1561–1568. - PubMed

MeSH terms

Feedback