Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score-matching analysis
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ORIGINAL ARTICLE
Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score‑matching analysis Koji Shindo1 · Jaymel Castillo1,2 · Kenoki Ohuchida1 · Taiki Moriyama1,3 · Shuntaro Nagai1 · Tomohiko Moriyama2,4 · Takao Ohtsuka1,3 · Eishi Nagai1,5 · Shuji Shimizu1,2 · Masufumi Nakamura1 Received: 20 January 2020 / Accepted: 13 April 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose There is no definite evidence of the feasibility and safety of laparoscopic distal gastrectomy (LDG) for patients who have undergone incomplete endoscopic resection (ER). We investigated the influence of ER prior to LDG by a propensity score matching analysis. Methods We retrospectively analyzed the outcomes of gastric cancer patients who underwent LDG with or without prior ER from 2000 to 2014. Propensity score matching was performed to compare the two groups of patients. Results After matching, 47 patients in the ER group and 94 patients in the non-ER group were selected from a total of 365 patients. A residual tumor was observed in 10 of 47 patients (21.3%). The mean number of dissected lymph nodes in the non-ER group (39.4 ± 14.5) was higher than that in the ER group (31.7 ± 13.5) (P = 0.003). However, other perioperative data, such as the operation time and blood loss volume were similar. The complication rate of the ER group (17.0%) and the non-ER group (9.6%) did not differ to a statistically significant extent (P = 0.2). Among these patients, 6 died during the 5-year follow-up period, but no patients showed signs of recurrence. Conclusion ER prior to surgical resection showed no significant influence on postoperative complications or mortality. LDG can be safely performed to achieve radical resection after incomplete ER. Keywords Endoscopic resection · Gastric cancer · Laparoscopic distal gastrectomy Abbreviations ER Endoscopic resection ESD Endoscopic submucosal dissection EMR Endoscopic mucosal resection
LDG Laparoscopic distal gastrectomy LADG Laparoscopy-assisted distal gastrectomy
Koji Shindo and Jaymel Castillo Co-first authors.
Gastric cancer is the fifth most common cancer worldwide [1]. In Japan, most cases of gastric cancer are detected at an early stage, which contributes to a better overall survival rate than other countries in developing countries and also Western developed countries [2]. This early detection is due to the implementation of organized and efficient screening guidelines for gastric cancer in Japan. In 1971, the Japanese Society of Gastroenterology and Endoscopy defined early gastric cancer as carcinoma limited to the mucosa and/or submucosa, regardless of the lymph node status [3]. Endoscopic treatments for early gastric cancer, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), have markedly progressed and are widely accepted. Several tumor
* Kenoki Ohuchida [email protected]‑u.ac.jp 1
Departments of Surgery and Oncology, Kyushu University Hospital, 3‑1‑1 Maidashi, Higashiku, Fukuokashi, Fukuoka,
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