Influence of endoscopic submucosal dissection on additional gastric resections

Abstract

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.

The value of diagnostic endoscopic submucosal dissection for patients with clinical submucosal invasive early gastric cancer

“…A high prevalence of D2 lymphadenectomy was recorded because we used this treatment strategy for all cases with positive vertical margins even though the patients had early gastric cancer. We reported previously that it is rare for preceding ESD to necessitate alterations in gastric resection [19]. Forced conversion to total gastrectomy due to the effects of preceding ESD is a potential risk for patients, and this occurred in only one patient in the present study.…”

Additional Gastrectomy after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

“…Several studies [14][15][16] support similar results but also point that adhesion may result in difficult surgery and greater blood loss, and intended operative procedure can be changed due to contraction of the ESD scar near pylorus or cardia. [13][14][15]17 As all we know, laparoscopic gastrectomy has become standard treatment for early gastric cancer. Laparoscopic gastrectomy with adequate lymph node dissection can be safely applied for patients with non-curative ESD regarding postoperative complications and oncologic outcomes.…”

Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection: a propensity score matching analysis

“…No relationship between the interval and perioperative outcome was recognized in this study. Kawata et al [18] reported no influence of additional gastric resection after ESD. However, they performed open gastrectomy for 93% cases (236/261 cases).…”