Intraoperative gastroscopy to determine proximal resection margin during totally laparoscopic gastrectomy for patients with upper third gastric cancer

Abstract

Background: In totally laparoscopic gastrectomy (TLG), it is usually difficult to determine the proximal margin. Therefore, the present study evaluated the usefulness of intraoperative gastroscopy for direct marking of the tumor proximal margin during TLG for cancer in the upper third of the stomach. Methods: This retrospective cohort study included 52 patients with gastric cancer who underwent TLG from January 2018 to May 2020. The proximal margin of tumors was determined by intraoperative gastroscopic methods. Results: Patients were divided into short (1 cm) and long (2 cm) groups according to the distance to the proximal margin of the tumor. Participants consisted of 41 males and 11 females with a median age of 63.5 years. Tumors involving the esophagogastric junction (EGJ) occurred in 27 patients. Siewert type II and III tumors were present in 42 and 10 patients, respectively. The median operative time was 244 min. The long group had a statistically significant lower frequency of positive margin than the short group (0% vs. 17.4%, P=0.033). Total gastrectomy was performed in 35 patients, and 17 patients received proximal gastrectomy.No complications associated with the procedure occurred in any patient. Conclusions: Intraoperative endoscopic views for tumor proximal localization can be used effectively during TLG for patients with upper third gastric cancer. Our results indicate that a distance of ≥2 cm from the proximal resection margin to the tumor was necessary to achieve a negative resection margin. In the future, this may be used as an alternative to frozen section diagnosis.

Endoscopy in surgery

“…Consequently, FE supports decision-making by determining the tumor location at the epicenter or from the majority of tumor masses. Additionally, intraoperative endoscopic assessment enables real-time evaluation of proximal tumor extent ensuring at least a 2cm distance from the tumor margin for R0 resections (28).…”

Prevention and treatment of a positive proximal margin after gastrectomy for cardia cancer

“…There is no consensus about the length of macroscopic appearing normal oesophagus that should be resected [40]. Some studies suggested minimum of 2 cm [14,41]. However, it can be challenging to resect more oesophagus via the abdomen and still leave room for a safe oesophagojejunostomy.…”