Laparoscopic gastrectomy after incomplete endoscopic resection for early gastric cancer

Abstract

Abstract. Endoscopic submucosal dissection (ESD) utilizes electrical coagulation, which can cause burns, fibrosis and adhesion of the stomach and surrounding tissue; these complications might increase the surgical difficulties for subsequent laparoscopy-assisted gastrectomy (LAG) and the risk of complications. However, scarce data are available on the influence of previous ESD on LAG. The purpose of this study was to evaluate the feasibility and safety of LAG following incomplete ESD in patients with early gastric cancer. Ninety-seven patients who underwent LAG were analyzed retrospectively; 17 patients had undergone ESD previously and the remaining 80 patients had no history of ESD. Clinicopathological data and surgical outcomes were compared between the two groups. No differences were observed in surgical outcomes of LAG after ESD in terms of operation time, intraoperative blood loss, total number of harvested lymph nodes, time until start of flatus, and postoperative hospital stay. These results were not influenced by tumor location and operative procedures. In conclusion, in terms of surgical outcomes, LAG is a safe and feasible procedure for the treatment of early gastric cancer regardless of previous endoscopic treatment. LAG may be the first-choice radical treatment after incomplete ESD for early gastric cancer.

Laparoscopic surgery after endoscopic resection for rectal cancer and neuroendocrine tumors

“…These changes may increase the technical difficulty of subsequent laparoscopic surgery and thus increase the risk of complications. There have been reports about laparoscopic surgery after ER for gastric cancer [14,15], but no study to our knowledge of laparoscopic surgery after ER for rectal tumors.…”

Influence of endoscopic submucosal dissection on additional gastric resections

“…A pathological study using gastrectomy specimens obtained by noncurative ESD reported that fibrosis was observed in the muscle layer proper or deeper [13]. Intraabdominal adhesions induced by ESD ulceration reportedly result in time-consuming procedures and greater blood loss during additional laparoscopic gastrectomy [23], whereas others have reported little to no influence on early postoperative outcomes [14,15]. Tsujimoto et al [15] reported no difference in operation duration and intraoperative blood loss between laparoscopic gastrectomy with or without preceding ESD.…”

“…Intraabdominal adhesions induced by ESD ulceration reportedly result in time-consuming procedures and greater blood loss during additional laparoscopic gastrectomy [23], whereas others have reported little to no influence on early postoperative outcomes [14,15]. Tsujimoto et al [15] reported no difference in operation duration and intraoperative blood loss between laparoscopic gastrectomy with or without preceding ESD. In our study, we experienced only one case of intraabdominal adhesion induced by ESD that required partial resection of the mesocolon.…”

“…Because of the growing incidence of EGC in Japan, several minimally invasive surgical procedures have been developed, such as ESD, laparoscopic surgery, and PPG [11,[14][15][16]. PPG has been reported as a safe and effective surgery in terms of nutritional advantage and a lower incidence of gallstone [17][18][19].…”

“…Although some studies have reported that laparoscopic surgery after noncurative ESD is a safe and feasible procedure [14,15], no reports about the influence of ESD on additional gastric resections exist. Therefore, this study aimed to clarify the influence of preceding ESD on additional gastric resections among patients who failed to achieve curative ESD.…”