Clinical influence of endoscopic resection on subsequent laparoscopic gastrectomy for gastric cancer

Abstract

Background: Endoscopic resection (ER) causes inflammation, edema, fibrosis of the stomach, and severe adhesions around the surrounding tissue. However, little is known about the clinical influence of ER on subsequent laparoscopic gastrectomy (LG) for gastric cancer.

Patients and methods: Between October 2007 and April 2011, 202 consecutive patients underwent curative LG for gastric cancer. Out of these, 30 (15%) LG cases had previously undergone ER and further LG to achieve a cure. The remaining 172 patients (85%) had no history of ER. We reviewed their hospital records retrospectively.

Results: Intraperitoneal adhesions were detected in all patients after ER. However, there were no significant differences in clinical outcome, such as surgical duration, blood loss, number of dissected lymph nodes, complications, or hospital stay, between LG cases with and those without previous ER. Of the 30 cases of LG with previous ER, 15 treated within two months after ER had greater blood loss (p<0.005) and a longer surgical duration (p=0.06). LG cases with major or minor perforation during ER also had slightly greater blood loss (p=0.07) than those without. However, the number of dissected lymph nodes associated with surgical curability and postoperative complications were not significantly different in patients with and those without these clinical factors.

Conclusion: LG can be performed curatively and safely even after ER. Perforation during ER and shorter time to LG after ER may be potential risks of surgical difficulty in subsequent LG.

Keywords: Gastric cancer; adhesion; endoscopic resection; laparoscopic gastrectomy; perforation.