title: Influence of endoscopic submucosal dissection on additional gastric resections.
abstract: BACKGROUND
  Widespread application of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) results in noncurative resection in some patients. The influence of preceding ESD on additional gastric resections has not been completely evaluated.
  
  
  METHODS
  Endoscopic, surgical, and pathological records of 255 patients who underwent additional gastrectomy after noncurative ESD at a single prefectural cancer center from September 2002 to December 2010 were reviewed. The estimated gastric resection based on endoscopic images before ESD was compared with the actual gastric resection performed after ESD.
  
  
  RESULTS
  Altered gastric resection was performed in 4 (1.6%) of the 255 patients. In 3 patients, total gastrectomy was performed instead of distal gastrectomy; in 1 patient, distal gastrectomy was performed instead of pylorus-preserving gastrectomy because of an insufficient distance from the cardia or pylorus caused by contraction of the ESD scar. Standard gastrectomy including total or distal gastrectomy with D2 lymph node dissection was performed in 33 patients because of deep submucosal invasion with positive/indefinite vertical margins. The final pathology revealed pT2 or deeper in 10 patients.
  
  
  CONCLUSIONS
  In conclusion, 98.4% patients underwent the scheduled gastric resection before ESD, and the preceding gastric ESD had almost no influence on changing the gastric resection of the additional surgery. Although rare, the preceding ESD may necessitate alterations in gastric resection to widen the surgical area because of contraction of ESD scar for lesions near the cardia or pylorus. MINI ABSTRACT: A retrospective study of additional gastrectomy after noncurative ESD showed that the preceding ESD had almost no influence on changing the gastric resection of the additional surgery.
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 4118777, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Kawata
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sawai
authors.forename: Kohei
authors.initials: K
authors.lastname: Takizawa
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Imai
authors.forename: Kinichi
authors.initials: K
authors.lastname: Hotta
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.forename: Etsuro
authors.initials: E
authors.lastname: Bando
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*