title: Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection: a propensity score matching analysis.
abstract: OBJECTIVE
  A recently developed endoscopic mucosal resection (EMR) procedure, endoscopic submucosal dissection (ESD), makes en bloc resection possible for mucosal cancer regardless of lesion size. ESD involves deeper and wider dissection of the gastric wall and may therefore increase the difficulty of subsequent totally laparoscopic gastrectomy (TLG) and the risk of complications. However, the influence of ESD on subsequent TLG has yet to be demonstrated. The purpose of the present study was to clarify the influence of ESD on subsequent TLG.
  
  
  METHODS
  Between March 2006 and December 2013, we retrospectively collected data of 38 patients undergoing TLG with ESD (ESD group) and propensity score-matched 38 patients undergone TLG without ESD (non-ESD group) for treatment of gastric cancer at Tonan Hospital and Hokkaido University Hospital. The covariates for propensity score matching were as follows: age, sex, American Society of Anesthesiologists score, body mass index, and type of surgery. Clinicopathologic characteristics and surgical outcomes were compared between the two groups.
  
  
  RESULTS
  Operative times for TLG in ESD group and non-ESD group were 228.2 ± 53.9 and 228.1 ± 52.7 min (P = 0.989), and blood loss was 45.7 ± 83.0 and 71.3 ± 74.5 g, respectively (P = 0.161). There were no significant differences between the groups of ESD and non-ESD in postoperative recovery and postoperative complications. In totally laparoscopic distal gastrectomy (TLDG), the patients with ESD-resected specimens of more than 50 mm in diameter had significantly longer operative times (P = 0.009).
  
  
  CONCLUSIONS
  In this study, TLG is a feasible procedure treatment of gastric cancer regardless of ESD. However, TLDG is more difficult in cases where the ESD-resected specimen is more than 50 mm in diameter.
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. yuma-ebi@wc4.so-net.ne.jp.
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.affiliation: Departments of Surgery, Tonan Hospital, N1W6, Chuo-ku, Sapporo, Hokkaido, 060-0001, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Kurashima
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Murakami
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Tamoto
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okamura
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D061646:Operative Time; D057216:Propensity Score; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Early gastric cancer; Endoscopic submucosal dissection; Totally laparoscopic gastrectomy