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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Funding

This study was supported by a grant from the Seoul National University Hospital research fund (grant number 04-2019-3120). The funder had no role in the study design, data analysis, or writing of this article.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Shin-Hoo Park, Hyuk-Joon Lee, Ji-Ho Park, Tae-Han Kim, Young-Gil Son, Yeon-Ju Huh, Jong-Ho Choi, Sa-Hong Kim, Ji-Hyeon Park, Yun-Suhk Suh, Seong-Ho Kong, Do Joong Park & Han-Kwang Yang

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Hyuk-Joon Lee & Han-Kwang Yang

  3. Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea

    Ji-Ho Park

  4. Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea

    Tae-Han Kim

  5. Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea

    Young-Gil Son

  6. Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul, Korea

    Hyunsoo Chung

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  1. Shin-Hoo Park
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Contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: Shin-Hoo Park, Ji-Ho Park, Tae-Han Kim, Young-Gil Son, Yeon-Ju Huh, Ji-Hyun Park, Jong-Ho Choi, Sa-Hong Kim, Yun-Suhk Suh, Hyunsoo Chung, Seong-Ho Kong, Do Joong Park, Hyuk-Joon Lee, and Han-Kwang Yang

Drafting the work or revising it critically for important intellectual content: Shin-Hoo Park, Jong-Ho Choi, Tae-Han Kim, Ji-Ho Park, Young-Gil Son, Yeon-Ju Huh, Yun-Suhk Suh, Hyunsoo Chung, Seong-Ho Kong, Do Joong Park, and Han-Kwang Yang

Final approval of the version to be published: Shin-Hoo Park, Seong-Ho Kong, Do Joong Park, Hyuk-Joon Lee, and Han-Kwang Yang

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Shin-Hoo Park, Ji-Ho Park, Tae-Han Kim, Yun-Suhk Suh, Hyunsoo Chung, Hyuk-Joon Lee, Seong-Ho Kong, Do Joong Park, and Han-Kwang Yang

Corresponding author

Correspondence to Hyuk-Joon Lee.

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Human Rights Statement and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The requirement for written consent was waived by the IRB because of the retrospective nature of this study.

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The authors declare that they have no conflict of interest.

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Park, SH., Lee, HJ., Park, JH. et al. Clinical Significance of Intra-operative Gastroscopy for Tumor Localization in Totally Laparoscopic Partial Gastrectomy. J Gastrointest Surg 25, 1134–1146 (2021). https://doi.org/10.1007/s11605-020-04809-x

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