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

Abstract

<p> <span>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.<span> 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 trea</span>tment of choice for non-curative endoscopic resection.</span> </p> <p> <span></span> </p

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

“…Our study had a few limitations, despite having a relatively higher number of patients with ESD compared to previously published studies [ 12 15 ]. This study was a single-center retrospective study, and the number of individuals in the ESD-surgery group was relatively smaller than in the surgery-only group.…”

“…However, the surgical complications of laparoscopic gastrectomy after ESD have not been well documented, despite the expected deleterious effect of ESD on surgery. 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.…”

“…Patients underwent laparoscopic gastrectomy within 1–2 months post-ESD [ 15 ]. Another study [ 12 ] reported an average interval of 42.4 days from ESD to surgery. In our study, the mean interval from ESD to laparoscopic gastrectomy was 43.03 days, which was similar to previous studies.…”

Interaction between Medical Treatment and Minimally Invasive Surgical Treatment for the Malignancies of the Digestive Tract

“…Laparoscopic gastrectomy has been on the path of becoming a standard treatment for Stage I disease not only because of the smaller surgical wound in the case of abdominal surgery but also because of reduced pain, blood loss, and more rapid postoperative recovery [12-14]. It has also been shown that laparoscopy-assisted distal gastrectomy is in no way inferior to abdominal surgery in terms of the therapeutic results, even as an additional surgical procedure, in patients who have undergone a noncurative resection by ESD [15]. However, since the postoperative disorders are associated with gastrectomy or lymphadenectomy, the so-called small stomach symptoms of dumping and diarrhea can also occur after this procedure just as in the case of abdominal surgery, which is a next-generation organ-conserving reduction surgery, with focus on the long-term QOL.…”