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Endoscopic resection and laparoscopic lymph node dissection for early gastric cancer beyond conventional endoscopic treatment indications: a 10-year outcome study

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Abstract

Background

Endoscopic full-thickness gastric resection (EFTGR) with laparoscopic regional lymph node dissection (LLND) and endoscopic submucosal dissection (ESD) with LLND have been investigated as treatment options for early gastric cancer beyond the absolute indications for ESD. However, comparative studies on the long-term outcomes of these procedures are lacking. This study aimed to analyze and compare the 10-year outcomes of both procedures in a real clinical setting.

Methods

Between January 2009 and December 2013, 28 and 37 patients diagnosed with EGC beyond the absolute indications for ESD were treated with EFTGR with LLND and ESD with LLND, respectively. In both procedures, the dye was injected into the tumor. However, after injection and LLND, EFTGR was performed immediately in the EFTGR with LLND group, whereas LLND was followed by ESD in the ESD with LLND group. The primary endpoint was the 10-year survival rate.

Results

The EFTGR with LLND group had one case of local recurrence (3.6%) and mortality (3.6%) each, while the ESD with LLND group had none (0.0% for both); however, the differences were not statistically significant (P = 0.247 for each). Furthermore, there was no significant difference in complications such as ischemia and anastomosis leakage between the groups (P = 0.247).

Conclusions

When the procedures were properly applied, EFTGR with LLND and ESD with LLND did not increase the 10-year mortality in patients with EGC beyond the absolute ESD indications compared with conventional radical gastrectomy.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Cha Gangnam Medical Center, College of Medicine, Cha University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, Republic of Korea

    Ah Young Lee, Sungwoo Cho, Seong Hwan Kim & Joo Young Cho

  2. Metabolic and Bariatric Surgery Center, Hplus Yangji Hospital, Seoul, Republic of Korea

    Yong Jin Kim

  3. Institute for Digestive Research, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Tae Hee Lee

  4. Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea

    Jun-Young Seo

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Contributions

Data curation, formal analysis, investigation, methodology, and writing-original draft: AYL; conceptualization, visualization, supervision, writing-review, and editing: JYC; writing—review and editing: J-YS, YJK, THL, SWC, and SHK provided final approval for the article.

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Correspondence to Joo Young Cho.

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Ah Young Lee, Yong Jin Kim, Sungwoo Cho, Tae Hee Lee, Jun-Young Seo, Seong Hwan Kim, and Joo Young Cho have no conflicts of interest or financial ties to disclose.

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Lee, A.Y., Kim, Y.J., Cho, S. et al. Endoscopic resection and laparoscopic lymph node dissection for early gastric cancer beyond conventional endoscopic treatment indications: a 10-year outcome study. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10761-7

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