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Short-term efficacy of additional laparoscopic-assisted radical gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer

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Abstract

Objective

To investigate short-term efficacy of direct laparoscopic-assisted radical gastrectomy (LAG) versus non-curative endoscopic submucosal dissection (ESD) plus additional LAG for early gastric cancer.

Materials and methods

286 patients were retrospectively assigned into two groups: direct LAG group (n = 255) and additional LAG (ESD plus LAG, n = 31) group. A 1:2 propensity score matching was performed to equalize relevant confounding factors between two groups for analysis.

Results

Ninety-three patients were successfully matched, including 62 in the direct LAG group and 31 in the additional LAG group. A significant (P = 0.013) difference existed in the drainage removal time between the additional LAG and direct LAG group (7 d vs. 6 d). Age, sex, tumor location and surgical approach were significantly (P < 0.05) associated with complications, with age ≥ 60 years (P = 0.002) and total gastrectomy (P = 0.011) as significant independent risk factors. A significant (P = 0.023) difference existed in the surgical time between the early and late groups (193.3 ± 37.6 min vs. 165.5 ± 25.1 min).

Conclusion

Additional LAG (D1 + lymphadenectomy) after ESD may be safe and effective even though non-curative ESD may prolong the drainage removal time and increase the difficulty of surgery.

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Data availability

The data used for this study will be available from the corresponding author on reasonable account.

References

  1. Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin 71(3):209–249

    Article  PubMed  Google Scholar 

  2. Chen W, Zheng R, Baade PD et al (2016) Cancer statistics in China, 2015[J]. CA Cancer J Clin 66(2):115–132

    Article  PubMed  Google Scholar 

  3. Ohnita K, Isomoto H, Shikuwa S et al (2014) Early and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in a large patient series[J]. Exp Ther Med 7(3):594–598

    Article  PubMed  PubMed Central  Google Scholar 

  4. Katai H, Ishikawa T, Akazawa K et al (2018) Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007)[J]. Gastric Cancer 21(1):144–154

    Article  PubMed  Google Scholar 

  5. Liu Q, Ding L, Qiu X, Meng F (2020) Updated evaluation of endoscopic submucosal dissection versus surgery for early gastric cancer: A systematic review and meta-analysis. Int J Surg 73:28–41

    Article  PubMed  Google Scholar 

  6. Wang L, Shen J, Zhang X, Lu H, Chu W (2021) Retrospective analysis of the clinical effects of endoscopic mucosal dissection on treatment of early esophagogastric precancerous lesions. Clin Transl Oncol 23(4):731–737

    Article  CAS  PubMed  Google Scholar 

  7. Embaye KS, Zhang C, Ghebrehiwet MA, Wang Z, Zhang F, Liu L, Qin S, Qin L, Wang J, Wang X (2021) Clinico-pathologic determinants of non-e-curative outcome following en-bloc endoscopic submucosal dissection in patients with early gastric neoplasia. BMC Cancer 21(1):92

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gong Y, Zhang YM, Zhu JQ, He S, Dou LZ, Liu Y, Ke Y, Liu XD, Liu YM, Wu HR, Lyu Y, Wang GQ (2021) Analysis of risk factors for delayed bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm. Zhonghua Zhong Liu Za Zhi 43(8):861–865

    CAS  PubMed  Google Scholar 

  9. Lee H, Lee HH, Song KY et al (2020) Negative impact of endoscopic submucosal dissection on short-term surgical outcomes of subsequent laparoscopic distal gastrectomy for gastric cancer[J]. Ann Surg Oncol 27(1):313–320

    Article  PubMed  Google Scholar 

  10. (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition)[J]. Gastric Cancer 24(1):1–21

  11. Akagi T, Shiraishi N, Hiroishi K et al (2010) Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy[J]. Gastrointest Endosc 72(2):438–443

    Article  PubMed  Google Scholar 

  12. Tsujimoto H, Yaguchi Y, Kumano I et al (2012) Laparoscopic gastrectomy after incomplete endoscopic resection for early gastric cancer[J]. Oncol Rep 28(6):2205–2210

    Article  PubMed  Google Scholar 

  13. Lee EG, Ryu KW, Eom BW et al (2017) The effect of endoscopic resection on short-term surgical outcomes in patients with additional laparoscopic gastrectomy after non-curative resection for gastric cancer[J]. J Gastric Cancer 17(1):33–42

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jiang X, Hiki N, Yoshiba H et al (2011) Laparoscopy-assisted gastrectomy in patients with previous endoscopic resection for early gastric cancer[J]. Br J Surg 98(3):385–390

    Article  CAS  PubMed  Google Scholar 

  15. Yang JY, Webster-Clark M, Lund JL, Sandler RS, Dellon ES, Stürmer T (2019) Propensity score methods to control for confounding in observational cohort studies: a statistical primer and application to endoscopy research. Gastrointest Endosc 90(3):360–369

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sumiyama K (2017) Past and current trends in endoscopic diagnosis for early stage gastric cancer in Japan[J]. Gastric Cancer 20(Suppl 1):20–27

    Article  PubMed  Google Scholar 

  17. Hong S, Won YJ, Lee JJ et al (2021) Cancer statistics in Korea: Incidence, mortality, survival, and prevalence in 2018[J]. Cancer Res Treat 53(2):301–315

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European society of gastrointestinal endoscopy (ESGE) guideline. Endoscopy 47(9):829–854

    Article  PubMed  Google Scholar 

  19. Choi MK, Kim GH, Park DY et al (2013) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience[J]. Surg Endosc 27(11):4250–4258

    Article  PubMed  Google Scholar 

  20. Ryu SJ, Kim BW, Kim BG et al (2016) Endoscopic submucosal dissection versus surgical resection for early gastric cancer: a retrospective multicenter study on immediate and long-term outcome over 5 years[J]. Surg Endosc 30(12):5283–5289

    Article  PubMed  Google Scholar 

  21. Kim ER, Lee H, Min BH et al (2015) Effect of rescue surgery after non-curative endoscopic resection of early gastric cancer[J]. Br J Surg 102(11):1394–1401

    Article  CAS  PubMed  Google Scholar 

  22. Eom BW, Kim YI, Kim KH et al (2017) Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer[J]. Gastrointest Endosc 85(1):155-163.e3

    Article  PubMed  Google Scholar 

  23. Sunagawa H, Kinoshita T, Kaito A et al (2017) Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases[J]. Surg Today 47(2):202–209

    Article  PubMed  Google Scholar 

  24. Suzuki S, Gotoda T, Hatta W et al (2017) Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis[J]. Ann Surg Oncol 24(11):3353–3360

    Article  PubMed  Google Scholar 

  25. Ishida R, Kanaji S, Maehara R et al (2018) Significance of additional gastrectomy including endoscopic submucosal dissection scar for gastric cancer[J]. Anticancer Res 38(9):5289–5294

    Article  PubMed  Google Scholar 

  26. Katai H, Mizusawa J, Katayama H et al (2020) Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial[J]. Lancet Gastroenterol Hepatol 5(2):142–151

    Article  PubMed  Google Scholar 

  27. Kim HH, Han SU, Kim MC et al (2019) Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial[J]. JAMA Oncol 5(4):506–513

    Article  PubMed  PubMed Central  Google Scholar 

  28. Liu F, Huang C, Xu Z et al (2020) Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage I gastric cancer: The CLASS02 multicenter randomized clinical trial[J]. JAMA Oncol 6(10):1590–1597

    Article  PubMed  Google Scholar 

  29. Shindo K, Castillo J, Ohuchida K et al (2020) Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score-matching analysis[J]. Surg Today 50(10):1290–1296

    Article  PubMed  Google Scholar 

  30. Nelen SD, Bosscha K, Lemmens V et al (2018) Morbidity and mortality according to age following gastrectomy for gastric cancer[J]. Br J Surg 105(9):1163–1170

    Article  CAS  PubMed  Google Scholar 

  31. Zhao F, Cho I, Cho GS et al (2022) Effect of non-curative endoscopic submucosal dissection on short-term outcomes of subsequent surgery for early gastric cancer[J]. Asian J Surg 45(1):232–238

    Article  PubMed  Google Scholar 

  32. Sun YX, Zhu TY, Wang GJ, Gao BL, Li RX, Wang JT (2023) Thoracolaparoscopic radical esophagectomy for esophageal cancer based on the mesoesophageal theory. Sci Rep 13(1):8760

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Zhu TY, Deng XM, Wang GJ, Gao BL, Li RX, Zhang YF, Wang JT (2022) En bloc mesoesophageal esophagectomy through thoracoscopy combined with laparoscopy based on the mesoesophageal theory. Surg Endosc 36(8):5784–5793

    Article  PubMed  Google Scholar 

  34. Zhu TY, Deng XM, Wang GJ, Gao BL, Li RX, Wang JT (2022) Comparison of short-term surgical outcomes between complete mesenteric resection and traditional transhiatal laparoscopic surgery for Siewert type II/III esophagogastric junction adenocarcinoma. Langenbecks Arch Surg 407(8):3811–3818

    Article  PubMed  Google Scholar 

  35. Tian YT, Ma FH, Wang GQ, Zhang YM, Dou LZ, Xie YB, Zhong YX, Chen YT, Xu Q, Zhao DB (2019) Additional laparoscopic gastrectomy after noncurative endoscopic submucosal dissection for early gastric cancer: A single-center experience. World J Gastroenterol 25(29):3996–4006

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hwang SH, Park DJ, Kim HH, Hyung WJ, Hur H, Yang HK, Lee HJ, Kim HI, Kong SH, Kim YW, Lee HH, Kim BS, Park YK, Lee YJ, Ahn SH, Lee IS, Suh YS, Park JH, Ahn S, Han SU (2022) Short-term outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy for upper early gastric cancer: a KLASS 05 randomized clinical trial. J Gastric Cancer 22(2):94–106

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ebihara Y, Okushiba S, Kurashima Y, Noji T, Nakamura T, Murakami S, Tamoto E, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S (2015) Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection: a propensity score matching analysis. Langenbecks Arch Surg 400(8):967–972

    Article  PubMed  Google Scholar 

  38. Shimada S, Sawada N, Oae S, Seki J, Takano Y, Nakahara K, Takehara Y, Mukai S, Ishida F, Kudo SE (2022) Impact of non-curative endoscopic submucosal dissection on short- and long-term outcome of subsequent laparoscopic gastrectomy for pT1 gastric cancer. Surg Endosc 36(6):3985–3993

    Article  PubMed  Google Scholar 

  39. Tomita T, Kim Y, Yamasaki T et al (2012) Prospective randomized controlled trial to compare the effects of omeprazole and famotidine in preventing delayed bleeding and promoting ulcer healing after endoscopic submucosal dissection[J]. J Gastroenterol Hepatol 27(9):1441–1446

    Article  CAS  PubMed  Google Scholar 

  40. Goto O, Fujishiro M, Kodashima S et al (2011) Short-term healing process of artificial ulcers after gastric endoscopic submucosal dissection[J]. Gut Liver 5(3):293–297

    Article  PubMed  PubMed Central  Google Scholar 

  41. Cha JH, Kim JH, Kim HI et al (2019) The optimal timing of additional surgery after non-curative endoscopic resection to treat early gastric cancer: long-term follow-up study[J]. Sci Rep 9(1):18331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kim MJ, Kim JH, Lee YC et al (2014) Is there an optimal surgery time after endoscopic resection in early gastric cancer?[J]. Ann Surg Oncol 21(1):232–239

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the Key Research, Development, and Promotion Projects of Henan Province in 2020 (202102310117) and Key Scientific Research Projects of Colleges and Universities in Henan Province 20B320029.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China

    Zhi-Hao Hu, Jing-Tao Wang, Rui-Xin Li, Guo-Jun Wang & Bu-Lang Gao

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  1. Zhi-Hao Hu
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  2. Jing-Tao Wang
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  3. Rui-Xin Li
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Contributions

Study design: Guo-Jun Wang; Data collection: Zhi-Hao Hu, Jing-Tao Wang, Rui-Xin Li, Bu-Lang Gao; Data analysis: Zhi-Hao Hu, Bu-Lang Gao; Writing of the original version: Zhi-Hao Hu; Revision: Bu-Lang Gao; Approval: All authors.

Corresponding author

Correspondence to Guo-Jun Wang.

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The authors declare no competing interests.

Conflict of interest

Drs. Zhi-Hao Hu, Jing-Tao Wang, Rui-Xin Li, Guo-Jun Wang, Xiu-Mei Deng, and Bu-Lang Gao have no conflicts of interest or financial ties to disclose.

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Hu, ZH., Wang, JT., Li, RX. et al. Short-term efficacy of additional laparoscopic-assisted radical gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer. Langenbecks Arch Surg 408, 354 (2023). https://doi.org/10.1007/s00423-023-03085-y

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