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Comparing Laparoscopic to Endoscopic Resections of Gastric Tumors in a High Volume North American Center
Sara Najmeh*, Jonathan Cools-Lartigue, Lorenzo E. Ferri
Surgery, McGill University, Montreal, QC, Canada
Introduction: Laparoscopic gastrectomy provides excellent oncologic outcomes for appropriately selected patients with gastric cancer. Despite favorable outcomes, mortality rates of up to 5 % have been reported. Endoscopic Submucosal Dissection (ESD) as an organ sparing option in the management of early cancers of the foregut is becoming increasingly accepted and allows for the en-bloc removal of larger tumors. However there is very limited data of this procedure in North America. Accordingly, we sought to compare the short-term and oncologic outcomes associated with LG versus ESD for the treatment of gastric malignant and premalignant tumors.
Methods: All patients undergoing laparoscopic subtotal gastrectomy (LSG) or ESD from 2007 to 2013 for adenocarcinoma or dysplasia at a North American University hospital were identified from a prospectively collected database. Patients were dichotomized according to the surgical approach. Patient demographics, tumor characteristics, AJCC stage, oncologic outcome, length of stay (LOS) and postoperative complications were recorded. Data are presented as median (range). Mann-Whitney U and Fischer's exact test were used to determine significance.
Results: 122 patients with gastric cancer were identified of which 38 were treated by LSG (22/38) or ESD (16/38). Adenocarcinoma was present in 31 patients and dysplasia was present in 7. No difference between groups was appreciated with regard to patient age ((LSG 75.5 (51-86) vs ESD 74(40-85)), sex (LSG 13/21(59%)male vs ESD 9/16(56.2%)male) and tumor size (LSG 2.8(0.6-9) vs ESD 2.2(0.4-3.2)). Patients subject to ESD harbored more stage I lesions that did LSG patients (LSG 13/21(61.9%) vs ESD 10/10(100%)*) and none presented with stage II or III disease (LSG 3/21(14.3%) vs ESD 0/10 for stage II) and (LSG 5/21(23.8%) vs ESD 0/10 for stage III). No difference in the rate of R0 resection was observed between the groups (LSG 20/22 (90.1%) vs ESD 15/16 (93.7%)). Although no difference in overall complication rate was observed between the 2 groups (LSG 6/22(27.3%) vs ESD 4/16(25%)), their severity was greater in patients subject to LSG. Accordingly, LOS was significantly shorter in patients treated by ESD group (LSG 8.5(5-26) vs ESD 2.0(1-7)*).
Conclusions: In selected patients, endoscopic submucosal dissection is associated with improved short-term outcomes, and provides an appropriate oncologic resection compared to the laparoscopic approach.
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