Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy

Akagi, Tomonori; Shiraishi, Naoki; Hiroishi, Kazuaki; Etoh, Tsuyoshi; Yasuda, Kazuhiro; Kitano, Seigo

doi:10.1016/j.gie.2010.03.1066

Cited by 17 publications

(14 citation statements)

References 27 publications

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“…Suzuki et al [12] reported minor anastomotic leakage and pancreatic fistulas in patients who underwent LADG-ESD (16%), whereas no significant differences in blood loss or the time of surgery existed between patients who underwent LADG-ESD and who underwent LADG-standard. Akagi et al [8] reported that artificial ulceration after ESD caused severe intra-abdominal adhesions. And pathologic reports also showed the presence of inflammatory cell invasion and fibrosis formation.…”

Section: Discussionmentioning

confidence: 99%

“…And pathologic reports also showed the presence of inflammatory cell invasion and fibrosis formation. Intra-abdominal adhesions are associated with healing of the artificial ulceration [8]. …”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is recommended for patients of noncurative factors. However, many surgeons have concerns about the deleterious effect of ESD on the surgical procedure because ESD causes an artificial gastric ulcer, local inflammation, and intra-abdominal adhesions, and consequent technical difficulties in the additional laparoscopic gastrectomy [8]. In this study, we aimed to evaluate the effect of ESD on short-term surgical outcomes in patients who undergo an additional laparoscopic gastrectomy after a noncurative resective ESD procedure.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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PurposeEndoscopic 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 MethodsFrom 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.ResultsSeveral 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.ConclusionsESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Influence of endoscopic submucosal dissection on additional gastric resections

et al. 2014

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Background Widespread application of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) results in noncurative resection in some patients. The influence of preceding ESD on additional gastric resections has not been completely evaluated. Methods Endoscopic, surgical, and pathological records of 255 patients who underwent additional gastrectomy after noncurative ESD at a single prefectural cancer center from September 2002 to December 2010 were reviewed. The estimated gastric resection based on endoscopic images before ESD was compared with the actual gastric resection performed after ESD. Results Altered gastric resection was performed in 4 (1.6 %) of the 255 patients. In 3 patients, total gastrectomy was performed instead of distal gastrectomy; in 1 patient, distal gastrectomy was performed instead of pylorus-preserving gastrectomy because of an insufficient distance from the cardia or pylorus caused by contraction of the ESD scar. Standard gastrectomy including total or distal gastrectomy with D2 lymph node dissection was performed in 33 patients because of deep submucosal invasion with positive/indefinite vertical margins. The final pathology revealed pT2 or deeper in 10 patients. Conclusions In conclusion, 98.4 % patients underwent the scheduled gastric resection before ESD, and the preceding gastric ESD had almost no influence on changing the gastric resection of the additional surgery. Although rare, the preceding ESD may necessitate alterations in gastric resection to widen the surgical area because of contraction of ESD scar for lesions near the cardia or pylorus. Mini abstract A retrospective study of additional gastrectomy after noncurative ESD showed that the preceding ESD had almost no influence on changing the gastric resection of the additional surgery.

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“…As the number of ESDs for EGC increases, the number of patients who require additional gastrectomy with LN dissection after non-curative ESD is increasing. ESD may cause intra-abdominal adhesions, making additional laparoscopic gastrectomy technically difficult [19,20]. We retrospectively evaluated the safety and efficacy of laparoscopy-assisted distal gastrectomy (LADG) after noncurative ESD.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Laparoscopy-Assisted Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Retrospective Report

Suzuki¹,

Tanabe²,

Vu³

et al. 2013

JCT

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Background: This study aimed to determine the safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) after ESD. Methods: We reviewed patients with gastric cancer who underwent distal gastrectomy after non-curative ESD from May 2000 to July 2010, and classified them into LADG-ESD and open distal gastrectomy (ODG) after non-curative ESD (ODG-ESD). In addition, we analyzed the standard LADG (LADG-standard) during the same period. We retrospectively analyzed surgical outcomes and survival in these 3 groups. Pathological results after gastrectomy were compared between the LADG-ESD and ODG-ESD; Results: Sixty-one patients underwent distal gastrectomy after non-curative ESD. No differences in overall survival were found between the LADG-ESD and ODG-ESD. The average duration to surgery after ESD was 42.4 days. Although the average surgical duration and average length of hospital stay after surgery were longer in the LADG-ESD than in the ODG-ESD, number of LN dissections was statistically identical in these 2 groups. Operative complications in the LADG-ESD (16.0%) was higher than that in the LADG-standard (3.8% - 8.2%) but similar to that in the ODG-ESD (13.9%). Conclusion: The present study suggests that LADG contributes to the effectiveness of the treatment of choice for non-curative endoscopic resection.

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Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy

Cited by 17 publications

References 27 publications

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

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

Influence of endoscopic submucosal dissection on additional gastric resections

Safety and Efficacy of Laparoscopy-Assisted Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Retrospective Report

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