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Clinical Significance of Intra-operative Gastroscopy for Tumor Localization in Totally Laparoscopic Partial Gastrectomy

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Author(s)
Shin-Hoo ParkHyuk-Joon LeeJi-Ho ParkTae-Han KimYoung-Gil SonYeon-Ju HuhJong-Ho ChoiSa-Hong KimJi-Hyeon ParkYun-Suhk SuhHyunsoo ChungSeong-Ho KongDo Joong ParkHan-Kwang Yang
Keimyung Author(s)
Son, Young Gil
Department
Dept. of Surgery (외과학)
Journal Title
J Gastrointest Surg
Issued Date
2021
Volume
25
Issue
5
Keyword
Laparoscopic gastrectomyIntracorporeal anastomosisIntra-operative gastroscopyMargin safety
Abstract
Background:
Tumor localization during totally laparoscopic gastrectomy is challenging owing to the invisibility of tumors on the serosal surface. We aimed to evaluate the clinical significance of intra-operative gastroscopy in totally laparoscopic partial gastrectomy.

Methods:
We reviewed 1084 gastric cancer patients who underwent either intra- or extracorporeal partial gastrectomy between 2014 and 2018. The intracorporeal group with intra-operative gastroscopy (intra-operative gastroscopy group, n = 187), the intracorporeal group without intra-operative gastroscopy (non-intra-operative gastroscopy group, n = 267), and the extracorporeal group (n = 630) were evaluated for the adequacy of surgical resection margins. We assessed whether total gastrectomy could be avoided according to the performance of intra-operative gastroscopy if the tumor was located within 3-5 cm away from the gastroesophageal junction.

Results:
The proximal margin positivity was lesser in the intra-operative gastroscopy group than in the non-intra-operative gastroscopy group (0% versus 2.2%; P = 0.045) but similar to that in the extracorporeal group (0% versus 0.6%; P = 0.579). The number of cases with proximal resection margins < 1 cm was lower in the intra-operative gastroscopy group than in the non-intra-operative gastroscopy group (3.7% versus 9.4%; P = 0.025) but comparable with that in the extracorporeal group (3.7% versus 4.1%; P = 0.815). Among 94 patients with lesions located within 3-5 cm apart from the gastroesophageal junction, the intra-operative gastroscopy group (n = 47) had fewer patients who underwent total gastrectomy than the non-intra-operative gastroscopy group (n = 47) (12.8% versus 44.7%; P = 0.001). Intra-operative gastroscopy was the only independent factor that prevented total gastrectomy (P = 0.001).

Conclusion:
Intra-operative gastroscopy can provide margin safety during intracorporeal partial gastrectomy, avoiding unnecessary total gastrectomy.
Keimyung Author(s)(Kor)
손영길
Publisher
School of Medicine (의과대학)
Citation
Shin-Hoo Park et al. (2021). Clinical Significance of Intra-operative Gastroscopy for Tumor Localization in Totally Laparoscopic Partial Gastrectomy. J Gastrointest Surg, 25(5), 1134–1146. doi: 10.1007/s11605-020-04809-x
Type
Article
ISSN
1873-4626
Source
https://link.springer.com/article/10.1007%2Fs11605-020-04809-x#article-info
DOI
10.1007/s11605-020-04809-x
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43550
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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