Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2019; 25(29): 3996-4006
Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.3996
Additional laparoscopic gastrectomy after noncurative endoscopic submucosal dissection for early gastric cancer: A single-center experience
Yan-Tao Tian, Fu-Hai Ma, Gui-Qi Wang, Yue-Ming Zhang, Li-Zhou Dou, Yi-Bin Xie, Yu-Xin Zhong, Ying-Tai Chen, Quan Xu, Dong-Bing Zhao
Yan-Tao Tian, Fu-Hai Ma, Yi-Bin Xie, Yu-Xin Zhong, Ying-Tai Chen, Quan Xu, Dong-Bing Zhao, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Gui-Qi Wang, Yue-Ming Zhang, Li-Zhou Dou, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Tian YT and Ma FH contributed equally to this work and they were involved in study concept, data acquisition, analysis, and interpretation, and production of tables, wrote the first draft, and revised it critically in light of comments from other authors; Zhao DB was involved in study conception and design, data interpretation, manuscript revision, and discussion; Wang GQ, Zhang YM, Dou LZ, and Xu Q were involved in data acquisition and literature review; Xie YB, Zhong YX, and Chen YT were involved in the manuscript revision and discussion; all authors approved the final version submitted.
Supported by the National Natural Science Foundation of China, No. 81772642; Beijing Municipal Science and Technology Commission, No. Z161100000116045; and Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study, and the data were anonymously analyzed.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dong-Bing Zhao, MD, Doctor, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. dbzhao2003@sina.com
Telephone: +86-10-87787120 Fax: +86-10-87787120
Received: May 5, 2019
Peer-review started: May 6, 2019
First decision: June 10, 2019
Revised: June 28, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: August 7, 2019
Abstract
BACKGROUND

The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial.

AIM

To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD.

METHODS

We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January 2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients’ clinicopathological data and identified the predictors of residual cancer (RC) and lymph node metastasis (LNM).

RESULTS

Surgical specimens showed RC in ten (22.2%) patients and LNM in five (11.1%). Multivariate analysis revealed that positive horizontal margin [odds ratio (OR) = 13.393, 95% confidence interval (CI): 1.435-125, P = 0.023] and neural invasion (OR = 14.714, 95%CI: 1.087-199, P = 0.043) were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM (OR = 12.000, 95%CI: 1.197-120, P = 0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 µm. Postoperative complications after additional laparoscopic gastrectomy occurred in five (11.1%) patients, and no deaths occurred among patients with complications.

CONCLUSION

Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice.

Keywords: Early gastric cancer, Endoscopic submucosal dissection, Laparoscopic gastrectomy, Residual cancer, Lymph node metastasis

Core tip: It is controversial whether additional gastrectomy is necessary for all patients who do not meet the curative criteria after endoscopic submucosal dissection (ESD). Therefore, it would be valuable to determine which factors could increase the risk of residual cancer or lymph node metastasis in patients after noncurative ESD in order to avoid unnecessary surgery. We found that gastrectomy was necessary not only for patients who had a positive margin in ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD.