Additional laparoscopic gastrectomy after noncurative endoscopic submucosal dissection for early gastric cancer: A single-center experience

BACKGROUND The necessity of additional gastrectomy for early gastric cancer(EGC) patients who do not meet curative criteria after endoscopic submucosal dissection(ESD)is controversial.AIM To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD.METHODS We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients’ clinicopathological data and identified the predictors of residual cancer(RC) and lymph node metastasis(LNM).RESULTS Surgical specimens showed RC in ten(22.2%) patients and LNM in five(11.1%).Multivariate analysis revealed that positive horizontal margin [odds ratio(OR) =13.393, 95% confidence interval(CI): 1.435-125, P = 0.023] and neural invasion(OR = 14.714, 95%CI: 1.087-199, P = 0.043) were independent risk factors for RC.Undifferentiated type was an independent risk factor for LNM(OR = 12.000,95%CI: 1.197-120, P = 0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 μm. Postoperative complications after additional laparoscopic gastrectomy occurred in five(11.1%) patients, and no deaths occurred among patients with complications.CONCLUSION Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 μm. Laparoscopic gastrectomy is a safe,minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice.