Comparing Laparoscopic to Endoscopic Resections for Early Gastric Cancer in a High Volume North American Center.
Endoscopic submucosal dissection as an organ sparing option for early gastric cancer is becoming increasingly accepted as an alternative to laparoscopic gastrectomy. Given the very limited North American data, we sought to compare outcomes between endoscopic and laparoscopic resection of gastric malignant and premalignant tumors. Patients undergoing laparoscopic gastrectomy or endoscopic submucosal dissection from 2007 to 2014 for adenocarcinoma or dysplasia at the McGill University Health Center were identified from a prospectively collected database and dichotomized according to the surgical approach. Patient demographics, tumor characteristics, stage, oncologic outcome, length of stay, and postoperative complications were recorded. Of 155 patients with gastric cancer identified, 67 were treated by laparoscopic gastrectomy (n = 37) or endoscopic submucosal dissection (ESD) (n = 30). There were significantly more invasive lesions in the laparoscopic group and patients subject to ESD harbored more T1 lesions. No significant difference in the rate of R0 resection or overall complications was observed between the groups. Accordingly, length of stay was significantly shorter in the ESD group. There were no significant differences in terms of overall and disease-free survival. In selected patients, ESD is associated with improved short-term outcomes and provides an appropriate oncologic resection option in a North American patient cohort.
Department of Surgery, McGill University Health Center, Montreal, QC, Canada.
Sara
S
Najmeh
Department of Surgery, McGill University Health Center, Montreal, QC, Canada.
Jonathan
J
Cools-Lartigue
Department of Surgery, McGill University Health Center, Montreal, QC, Canada.|Steinberg-Bernstein Center for Minimally Invasive Surgery, Montreal, QC, Canada.
Carmen
C
Mueller
Department of Surgery, McGill University Health Center, Montreal, QC, Canada. lorenzo.ferri@mcgill.ca.|Steinberg-Bernstein Center for Minimally Invasive Surgery, Montreal, QC, Canada. lorenzo.ferri@mcgill.ca.|Division of Thoracic Surgery, McGill University, 1650 Cedar Ave, L9.112, Montreal, H3G 1A4, QC, Canada. lorenzo.ferri@mcgill.ca.
Lorenzo E
LE
Ferri
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D061847:Hospitals, High-Volume; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
Endoscopy; Gastric cancer; Laparoscopy; Submucosal dissection