A Study Of Laparoscopy-Assisted Distal Gastrectomy After Endoscopic Submucosal Dissection

Background and Objectives: Endoscopic submucosal dissection (ESD) is a new method for the curative treatment of early gastric cancer. However, when pathology revealed incomplete dissection and/or positive lymphatic or venous invasion, additional surgical resection should be necessary to be done. In these cases, laparoscopy-assisted distal gastrectomy (LADG) with lymphnode dissection has been chosen in our hospital. The aim of this study is to evaluate risk factors in cases of LADG following ESD in comparison with those in those of LADG. only. Patients and Methods: During the period January 2004 through December 2009, we treated 416 patients with early gastric cancer (ESD:242, LADG:42, LADG following ESD: 9, Open surgery:123). The abdominal adhesion state, intraoperative bleeding and operation time were compared between the two groups, LADG following ESD and LADG only. Results: No significant differences were found between these two groups in terms of the intraoperative bleeding and operation time. The abdominal adhesive state was more frequent in the LADG following ESD group than the LADG only group. Conclusions: We concluded that abdominal adhesions should be considered as a risk factor when additional resection is performed by LADG after ESD.