Endoscopy-assisted gastric resection: a safe and reliable procedure for tumor clearance during laparoscopic high distal or proximal gastrectomy

Preoperative endoscopic tattooing or clipping is generally used to delineate the tumor-free margin in surgery for early gastric cancer. However, it is sometimes difficult to identify the line of resection during laparoscopic gastrectomy. Between June 2003 and February 2008, we performed a total of 12 endoscopy-assisted gastric resections during laparoscopic gastrectomy for cancer, including four cases of high distal gastrectomy and eight cases of proximal gastrectomy. In the laparoscopic high distal gastrectomy cases, a surgeon performed transduodenal endoscopy to identify the clips before gastric resection. For totally laparoscopic proximal gastrectomy, an endoscopist performed transoral endoscopy to identify the clips placed in the distal margin of the lesion and to facilitate intracorporeal anastomosis. In all cases, we were able to observe clips as well as the primary lesion. Gastric resection was successfully performed with no positive margin. In the high distal gastrectomy group (n = 4), proximal and distal margins were 19.5 +/- A 2.1 (range, 10-35) mm and 1,185 +/- A 190.9 (range, 850-1,320) mm, respectively. In the proximal gastrectomy group (n = 8), proximal and distal margins were 21.3 +/- A 7.1 (range, 5-38) mm and 47.5 +/- A 3.5 (range, 15-75) mm, respectively. The intracorporeal side-to-side anastomosis during proximal gastrectomy was successfully performed using an endolinear stapler. Endoscopy-assisted gastric resection is a safe and reliable procedure for tumor clearance during laparoscopic high distal or proximal gastrectomy.