title: Clinical influence of endoscopic resection on subsequent laparoscopic gastrectomy for gastric cancer.
abstract: BACKGROUND
  Endoscopic resection (ER) causes inflammation, edema, fibrosis of the stomach, and severe adhesions around the surrounding tissue. However, little is known about the clinical influence of ER on subsequent laparoscopic gastrectomy (LG) for gastric cancer.
  
  
  METHODS
  Between October 2007 and April 2011, 202 consecutive patients underwent curative LG for gastric cancer. Out of these, 30 (15%) LG cases had previously undergone ER and further LG to achieve a cure. The remaining 172 patients (85%) had no history of ER. We reviewed their hospital records retrospectively.
  
  
  RESULTS
  Intraperitoneal adhesions were detected in all patients after ER. However, there were no significant differences in clinical outcome, such as surgical duration, blood loss, number of dissected lymph nodes, complications, or hospital stay, between LG cases with and those without previous ER. Of the 30 cases of LG with previous ER, 15 treated within two months after ER had greater blood loss (p<0.005) and a longer surgical duration (p=0.06). LG cases with major or minor perforation during ER also had slightly greater blood loss (p=0.07) than those without. However, the number of dissected lymph nodes associated with surgical curability and postoperative complications were not significantly different in patients with and those without these clinical factors.
  
  
  CONCLUSIONS
  LG can be performed curatively and safely even after ER. Perforation during ER and shorter time to LG after ER may be potential risks of surgical difficulty in subsequent LG.
authors.affiliation: and Daisuke Ichikawa, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. skomatsu@koto.kpu-m.ac.jp or ichikawa@koto.kpu-m.ac.jp.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimura
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Chohei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Gastric cancer; adhesion; endoscopic resection; laparoscopic gastrectomy; perforation