Clinical outcomes of laparoscopic and endoscopic cooperative surgery for submucosal tumors on the esophagogastric juncti
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ORIGINAL ARTICLE
Clinical outcomes of laparoscopic and endoscopic cooperative surgery for submucosal tumors on the esophagogastric junction: a retrospective single‑center analysis Junya Aoyama1 · Hirofumi Kawakubo1 · Satoru Matsuda1 · Shuhei Mayanagi1 · Kazumasa Fukuda1 · Tomoyuki Irino1 · Rieko Nakamura1 · Norihito Wada1 · Yuko Kitagawa1 Received: 7 April 2020 / Accepted: 21 May 2020 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2020
Abstract Background Laparoscopic and endoscopic cooperative surgery (LECS) technique for gastric submucosal tumor (SMT) has developed, but treatment of SMT on the esophagogastric junction (EGJ) remains technically difficult because excessive resection may result in postoperative transformation of the EGJ and cause stenosis, and intervention to lower esophageal sphincter may result in gastroesophageal reflux. The study aim was to evaluate the feasibility and safety of LECS for SMT on the EGJ. Methods Between September 2012 and December 2018, LECS was performed for 21 patients with SMTs on the EGJ. Fundoplication was performed after LECS according to the intraoperative findings for each case. The patients’ backgrounds, operative outcomes, and follow-up data, including endoscopic findings of gastroesophageal reflux disease (GERD) and proton pomp inhibitor (PPI) use, were reviewed. Results In all 21 cases, LECS was completed with a mean operation time of 225 min, and a mean blood loss of 8.8 mL. All patients were alive without recurrence within the mean follow-up period of 30.5 months. Both GERD and PPI use tended to be less frequent when fundoplication was performed, although these differences were not statistically significant. (7.7% vs. 37.5%; P = 0.091, 23.1% vs. 50.0%; P = 0.204, respectively). Conclusions We demonstrated the feasibility and safety of LECS for SMTs even on the EGJ. Fundoplication after LECS may be an approach for the prevention of postoperative reflux esophagitis. Future research is warranted to validate the efficacy of the addition of fundoplication. Keywords Laparoscopic and endoscopic cooperative surgery · Submucosal tumor · Esophagogastric junction · Fundoplication
Introduction Laparoscopic and endoscopic cooperative surgery (LECS) is a relatively new procedure for dissection of gastric submucosal tumor (SMT) that was first introduced in 2008 by Hiki et al. [1]. LECS is an excellent surgical technique that avoids excessive resection of the stomach wall by visualizing a cut line of the lesion from the inside of the lumen endoscopically. Therefore, this procedure makes it possible to maintain the function and shape of the stomach. In the * Hirofumi Kawakubo [email protected] 1
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
surgical treatment of gastric SMT, LECS has been shown to have the same or better surgical results than those of conventional laparoscopic resection or laparotomy [2–4]. However, treatment of SMT on the esophagogastric junctio
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