title: Laparoscopic management for local recurrence of early gastric cancer after endoscopic mucosal resection.
abstract: Endoscopic mucosal resection (EMR) is a widely accepted technique for early gastric cancer because it is minimally invasive; however, incomplete resection with subsequent cancer recurrence in the remnant remains a difficult problem. Generally, the margins of the local recurrence lesions are unclear, and second EMR is difficult to perform because of scar formation after the first EMR. We performed a laparoscopic treatment on six patients with residual lesions after EMR and reviewed the safety and efficacy of this management. Laparoscopic management consisted of two techniques: laparoscopic wedge resection with a lesion-lifting method and laparoscopic-assisted distal gastrectomy with mini-laparotomy. Cancerous lesions were completely resected with sufficient surgical margins circumferentially. Mean operative time was 171 min, mean estimated blood loss was 16.5 g, time to first walking was 1 day, duration of epidural analgesia was 2.2 days, and mean length of hospital stay was 13.5 days. There were no intra- and postoperative complications, no conversion to open surgery, and no recurrence after surgery. No patients died of gastric cancer during a median follow-up of 60.3 months (range, 38-84). Laparoscopic management for residual lesions of early gastric cancer after EMR is a safe, effective, and minimally invasive procedure by which curative resection can be expected.
authors.affiliation: Department of Surgery, NTT West Osaka Hospital, 2-6-40, Karasugatsuji, Osaka, 543-8922, Japan. yano-h@mhc.west.ntt.co.jp
authors.forename: H
authors.initials: H
authors.lastname: Yano
authors.forename: Y
authors.initials: Y
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Iwazawa
authors.forename: T
authors.initials: T
authors.lastname: Monden
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000601:surgery*