Impact of endoscopic resection on the choice of surgical procedure in patients with additional laparoscopic gastrectomy.
BACKGROUND
Additional surgery is recommended for patients with noncurative resection after endoscopic submucosal dissection (ESD) for early gastric cancer. Additional resection requires the excision of an area larger than that of the resected mucosa in ESD, which is larger than the lesion, with convergence of the gastric mucosa due to scarring. Thus, the selection of the surgical procedure for lesion removal in specific areas can be affected by ESD. This study therefore aimed to evaluate the impact of ESD on the selection of additional gastrectomy in patients with early gastric cancer in the boundary area between the upper third and middle third of the stomach (UM boundary region).


METHODS
Between January 2013 and June 2018, laparoscopic gastrectomy was performed in 89 patients with cT1N0M0 gastric cancer located only in the UM boundary region. The patients' backgrounds and surgical and pathological results were retrospectively investigated. The predictive factors for performing laparoscopic distal gastrectomy (LDG) were evaluated by multivariate analysis.


RESULTS
Among 89 patients, 23 patients underwent ESD before surgery. LDG was significantly less often performed in the ESD-surgery group than in the surgery-only group (34.8% vs. 72.7%; p = 0.003). Preoperative ESD was an independent negative predictor of LDG (odds ratio = 0.266; p = 0.025).


CONCLUSIONS
Preoperative ESD has an impact on the selection of the type of additional gastrectomy, including reducing the conduct of LDG for early gastric cancer in the UM boundary region.
['Aoyama|Junya|J|', 'Sakuramoto|Shinichi|S|', 'Miyawaki|Yutaka|Y|', 'Ito|Misato|M|', 'Ito|Sunao|S|', 'Watanabe|Kenji|K|', 'Oya|Shuichiro|S|', 'Fujiwara|Naoto|N|', 'Sugita|Hirofumi|H|', 'Nonaka|Kouichi|K|', 'Sato|Hiroshi|H|', 'Yasuda|Masanori|M|', 'Yamaguchi|Shigeki|S|']
D000230:Adenocarcinoma D000368:Aged D000069916:Endoscopic Mucosal Resection D005260:Female D005500:Follow-Up Studies D005743:Gastrectomy D005753:Gastric Mucosa D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D011379:Prognosis D012189:Retrospective Studies D013274:Stomach Neoplasms
Gastrectomy Endoscopic submucosal dissection Early gastric cancer Laparoscopy