Satoshi Kamiya1, Manabu Ohashi2, Satoshi Ida1, Koshi Kumagai1, Souya Nunobe1, Takeshi Sano1, Naoki Hiki1. 1. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan. 2. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan. manabu.ohashi@jfcr.or.jp.
Abstract
BACKGROUND: Laparoscopic subtotal gastrectomy (LsTG) has several advantages, including technical safety and preservation of postoperative function, compared with total or proximal gastrectomy for early gastric cancer. However, LsTG has some technical issues with respect to achieving a safe resection margin and patency in patients with lesions close to the cardia or fornix. When LsTG is performed for lesions located rather close to the cardia or fornix, conventional marking clips can physically hinder transection by an endoscopic linear stapler. Additionally, tracing the tumor boundary to create a precise resection line is difficult. To resolve these issues, we introduced a new marking technique called endoscopic cautery marking (ECM) involving the creation of small cauterized spots. METHODS: Of 791 patients who underwent laparoscopic gastrectomy from 2015 to 2017, 16 underwent LsTG with ECM. Before surgery, ECM was performed and the pathological tumor boundary was traced according to preoperative biopsies. Under intraoperative endoscopic guidance, we divided the stomach with an endoscopic linear stapler on the proximal side of the ECM site and examined the stump by pathological frozen section analysis to confirm the absence of cancer. RESULTS: The median length of the endoscopically measured distance from the esophagogastric junction to the tumor was 30.0 mm (range 15-40 mm), and the median pathological proximal margin was 11.5 mm (range 0-26 mm). Although the ECM site was completely resected in all patients, frozen section analysis showed a positive margin in one lesion, which had an unclear tumor boundary due to gastritis. For this patient, we converted the procedure to laparoscopic completion gastrectomy. No severe complications or recurrences occurred. CONCLUSIONS: LsTG with ECM was technically feasible, and short-term outcomes were acceptable in this preliminary study. Further experience and investigations are imperative to verify the oncological and functional implications of LsTG with ECM.
BACKGROUND: Laparoscopic subtotal gastrectomy (LsTG) has several advantages, including technical safety and preservation of postoperative function, compared with total or proximal gastrectomy for early gastric cancer. However, LsTG has some technical issues with respect to achieving a safe resection margin and patency in patients with lesions close to the cardia or fornix. When LsTG is performed for lesions located rather close to the cardia or fornix, conventional marking clips can physically hinder transection by an endoscopic linear stapler. Additionally, tracing the tumor boundary to create a precise resection line is difficult. To resolve these issues, we introduced a new marking technique called endoscopic cautery marking (ECM) involving the creation of small cauterized spots. METHODS: Of 791 patients who underwent laparoscopic gastrectomy from 2015 to 2017, 16 underwent LsTG with ECM. Before surgery, ECM was performed and the pathological tumor boundary was traced according to preoperative biopsies. Under intraoperative endoscopic guidance, we divided the stomach with an endoscopic linear stapler on the proximal side of the ECM site and examined the stump by pathological frozen section analysis to confirm the absence of cancer. RESULTS: The median length of the endoscopically measured distance from the esophagogastric junction to the tumor was 30.0 mm (range 15-40 mm), and the median pathological proximal margin was 11.5 mm (range 0-26 mm). Although the ECM site was completely resected in all patients, frozen section analysis showed a positive margin in one lesion, which had an unclear tumor boundary due to gastritis. For this patient, we converted the procedure to laparoscopic completion gastrectomy. No severe complications or recurrences occurred. CONCLUSIONS: LsTG with ECM was technically feasible, and short-term outcomes were acceptable in this preliminary study. Further experience and investigations are imperative to verify the oncological and functional implications of LsTG with ECM.
Authors: Lauren M Postlewait; Malcolm H Squires; David A Kooby; George A Poultsides; Sharon M Weber; Mark Bloomston; Ryan C Fields; Timothy M Pawlik; Konstantinos I Votanopoulos; Carl R Schmidt; Aslam Ejaz; Alexandra W Acher; David J Worhunsky; Neil Saunders; Douglas Swords; Linda X Jin; Clifford S Cho; Emily R Winslow; Kenneth Cardona; Charles A Staley; Shishir K Maithel Journal: J Surg Oncol Date: 2015-08-14 Impact factor: 3.454
Authors: Jung-Woo Woo; Keun Won Ryu; Ji Yeon Park; Bang Wool Eom; Mi Jung Kim; Hong Man Yoon; Sook Ryun Park; Myeong-Cherl Kook; Il Ju Choi; Young-Woo Kim; Young-Iee Park Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: I D Kostakis; A Alexandrou; E Armeni; C Damaskos; G Kouraklis; T Diamantis; C Tsigris Journal: Scand J Surg Date: 2016-06-23 Impact factor: 2.360