Clinical Significance of Intra-operative Gastroscopy for Tumor Localization in Totally Laparoscopic Partial Gastrectomy
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ORIGINAL ARTICLE
Clinical Significance of Intra-operative Gastroscopy for Tumor Localization in Totally Laparoscopic Partial Gastrectomy Shin-Hoo Park 1 & Hyuk-Joon Lee 1,2 & Ji-Ho Park 1,3 & Tae-Han Kim 1,4 & Young-Gil Son 1,5 & Yeon-Ju Huh 1 & Jong-Ho Choi 1 & Sa-Hong Kim 1 & Ji-Hyeon Park 1 & Yun-Suhk Suh 1 & Hyunsoo Chung 6 & Seong-Ho Kong 1 & Do Joong Park 1 & Han-Kwang Yang 1,2 Received: 13 May 2020 / Accepted: 22 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Tumor localization during totally laparoscopic gastrectomy is challenging owing to the invisibility of tumors on the serosal surface. We aimed to evaluate the clinical significance of intra-operative gastroscopy in totally laparoscopic partial gastrectomy. Methods We reviewed 1084 gastric cancer patients who underwent either intra- or extracorporeal partial gastrectomy between 2014 and 2018. The intracorporeal group with intra-operative gastroscopy (intra-operative gastroscopy group, n = 187), the intracorporeal group without intra-operative gastroscopy (non-intra-operative gastroscopy group, n = 267), and the extracorporeal group (n = 630) were evaluated for the adequacy of surgical resection margins. We assessed whether total gastrectomy could be avoided according to the performance of intra-operative gastroscopy if the tumor was located within 3–5 cm away from the gastroesophageal junction. Results The proximal margin positivity was lesser in the intra-operative gastroscopy group than in the non-intra-operative gastroscopy group (0% versus 2.2%; P = 0.045) but similar to that in the extracorporeal group (0% versus 0.6%; P = 0.579). The number of cases with proximal resection margins < 1 cm was lower in the intra-operative gastroscopy group than in the nonintra-operative gastroscopy group (3.7% versus 9.4%; P = 0.025) but comparable with that in the extracorporeal group (3.7% versus 4.1%; P = 0.815). Among 94 patients with lesions located within 3–5 cm apart from the gastroesophageal junction, the intra-operative gastroscopy group (n = 47) had fewer patients who underwent total gastrectomy than the non-intra-operative gastroscopy group (n = 47) (12.8% versus 44.7%; P = 0.001). Intra-operative gastroscopy was the only independent factor that prevented total gastrectomy (P = 0.001). Conclusion Intra-operative gastroscopy can provide margin safety during intracorporeal partial gastrectomy, avoiding unnecessary total gastrectomy. Keywords Laparoscopic gastrectomy . Intracorporeal anastomosis . Intra-operative gastroscopy . Margin safety
Introduction Gastroscopy has played an indispensable role in the diagnosis of gastric cancer, especially in the surgical localization of tumors.1 While operating, the locations of tumors are difficult to identify on the serosal surface in early gastric cancer. In the
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04809-x) contains supplementary material, which is available to authorized users. * Hyuk-Joon Lee appe98@snu
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