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Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection : a propensity score matching analysis

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Title: Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection : a propensity score matching analysis
Other Titles: Totally LG for gastric cancer after ESD
Authors: Ebihara, Yuma Browse this author →KAKEN DB
Okushiba, Shunichi Browse this author
Kurashima, Yo Browse this author
Noji, Takehiro Browse this author →KAKEN DB
Nakamura, Toru Browse this author →KAKEN DB
Murakami, Soichi Browse this author
Tamoto, Eiji Browse this author
Tsuchikawa, Takahiro Browse this author →KAKEN DB
Okamura, Keisuke Browse this author
Shichinohe, Toshiaki Browse this author →KAKEN DB
Hirano, Satoshi Browse this author →KAKEN DB
Keywords: Totally laparoscopic gastrectomy
Endoscopic submucosal dissection
Early gastric cancer
Issue Date: Dec-2015
Publisher: Springer
Journal Title: Langenbeck's Archives of Surgery
Volume: 400
Issue: 8
Start Page: 967
End Page: 972
Publisher DOI: 10.1007/s00423-015-1349-0
PMID: 26476630
Abstract: Purpose: A recently developed endoscopic mucosal resection (EMR) procedure, endoscopic submucosal dissection (ESD), makes en-bloc resection possible for mucosal cancer regardless of lesion size. ESD involves deeper and wider dissection of the gastric wall, and may therefore increase the difficulty of subsequent totally laparoscopic gastrectomy (TLG) and the risk of complications. However, the influence of ESD on subsequent TLG has yet to be demonstrated. The purpose of the present study was to clarify the influence of ESD on subsequent TLG. Methods: Between March 2006 and December 2013, we retrospectively collected data of 38 patients undergoing TLG with ESD (ESD Group) and propensity score matched 38 patients undergone TLG without ESD (non-ESD Group) for treatment of gastric cancer at Tonan Hospital and Hokkaido University Hospital. The covariates for propensity score matching were: age, sex, American Society of Anesthesiologists score, body mass index, and type of surgery. Clinicopathologic characteristics and surgical outcomes were compared between the two groups. Results: Operative times for TLG in ESD group and non-ESD group were 228.2 ± 53.9 and 228.1 ± 52.7 min (P=0.989), and blood loss was 45.7 ± 83.0, 71.3 ± 74.5 g, respectively (P=0.161). There were no significant differences between the groups of ESD and non-ESD in postoperative recovery and postoperative complications. In totally laparoscopic distal gastrectomy (TLDG), the patients with ESD-resected specimens of more than 50 mm in diameter had significantly longer operative times (P=0.009). Conclusions: In this study, TLG is feasible procedure treatment of gastric cancer regardless of ESD. However, TLDG is more difficult in cases where the ESD-resected specimen is more than 50 mm in diameter.
Rights: The final publication is available at
Type: article (author version)
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 海老原 裕磨

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