Additional laparoscopic gastrectomy after noncurative endoscopic submucosal dissection for early gastric cancer: A single-center experience

Table 1 Demographic characteristics of the patients

Characteristic	All patients (n = 45)
	Number	Percent
Age (yr)	58.24 ± 9.3
Gender
Male	34	75.6
Female	11	24.4
Abdominal operation history
Yes	8	17.8
No	37	82.2
ASA score
I-II	34	75.6
III-IV	11	24.4
Comorbidity
Any comorbidity	15	33.3
Hypertension	10	22.2
Diabetes	5	10.5
Coronary artery disease	2	11.1
Others	4	8.9
Surgical indication
Vertical margin positive	29	64.4
SM2	31	68.9
Horizontal margin positive	7	15.6
Lymphovascular invasion	19	42.2
Undifferentiated type	14	31.1
Suspected recurrence 3 mo after ESD	2	4.4
Interval (d)	47 ± 26
RC
Yes	10	22.2
No	35	77.8
LNM
Yes	5	11.1
No	40	88.9
Depth of invasion
T1a	9	20.0
T1b SM1	5	11.1
T1b SM2	26	57.8
T2	2	4.4
T3	3	6.7

RC: Residual cancer; LNM: Lymph node metastasis; ASA: American Society of Anesthesiologists; ESD: Endoscopic submucosal dissection.

Table 2 Characteristics of cases with and without residual cancer, n (%)

Characteristic	Residual cancer		P-value
	Yes (n = 10)	No (n = 35)
Location			1.000
Upper third	4 (23.5)	13 (76.5)
Middle third	2 (18.2)	9 (81.8)
Lower third	4 (23.5)	13 (76.5)
Macroscopic appearance			0.694
Elevated type	1 (25.0)	3 (75.0)
Surface type	9 (23.1)	30 (76.9)
Depressed type	0 (0)	2 (100)
Tumor size			0.720
< 3 cm	5 (19.2)	21 (80.8)
≥ 3 cm	5 (26.3)	14 (73.7)
Differentiation			1.000
Differentiated	7 (22.6)	24 (77.4)
Undifferentiated	3 (21.4)	11 (78.6)
Lauren type			0.722
Intestinal	4 (18.2)	18 (81.8)
Diffused/Mixed	6 (26.1)	17 (73.9)
Depth of invasion			0.469
Mucosal invasion/SM1	2 (14.3)	12 (85.7)
> SM1 invasion	8 (25.8)	23 (74.2)
Horizontal margin			0.034
Positive	4 (57.1)	3 (42.9)
Negative	6 (15.8)	32 (84.2)
Vertical margin			0.292
Positive	8 (27.6)	21 (72.4)
Negative	2 (12.5)	14 (87.5)
Lymphovascular invasion			1.000
Yes	4 (21.1)	15 (78.9)
No	6 (23.1)	20 (76.9)
Neural invasion			0.007
Yes	6 (54.5)	5 (45.5)
No	4 (11.8)	30 (88.2)

Table 3 Multivariate analysis of the risk factors for residual cancer

Risk factor	OR	95%CI	P-value
Vertical margin positive	0.670	0.065-6.909	0.737
Depth of invasion: > SM1	0.637	0.075-5.423	0.680
Horizontal margin positive	13.393	1.435-125	0.023
Neural invasion positive	18.495	1.585-215	0.020

OR: Odds ratio; CI: Confidence interval.

Table 4 Characteristics of patients with and without lymph node metastasis in surgical specimens, n (%)

Characteristic	LNM		P-value
	Yes (n = 5)	No (n = 40)
Location			0.417
Upper third	3 (17.6)	14 (86.7)
Middle third	0 (0)	11 (100)
Lower third	2 (11.8)	15 (88.2)
Macroscopic appearance			0.125
Elevated type	1 (25)	3 (75)
Surface type	3 (7.7)	36 (92.3)
Depressed type	1 (50)	1 (50)
Tumor size			1.000
< 3 cm	3 (11.5)	23 (89.5)
≥ 3 cm	2 (10.5)	17 (89.5)
Differentiation			0.027
Differentiated	1 (3.2)	30 (96.8)
Undifferentiated	4 (28.6)	10 (71.4)
Lauren type			0.665
Intestinal	3 (13.6)	19 (86.4)
Diffused/Mixed	2 (8.7)	21 (91.3)
Depth of invasion			0.305
Mucosal invasion/SM1	0 (0)	14 (100)
> SM1 invasion	5 (16.1)	26 (83.9)
Horizontal margin			0.577
Positive	0 (0)	7 (100)
Negative	5 (13.2)	33 (86.8)
Vertical margin			1.000
Positive	3 (10.3)	26 (89.7)
Negative	2 (12.5)	14 (87.5)
Lymphovascular invasion			0.636
Yes	3 (15.8)	16 (84.2)
No	2 (7.7)	24 (92.3)
Neural invasion			1.000
Yes	1 (9.1)	10 (90.9)
No	4 (11.8)	30 (88.2)

LNM: Lymph node metastasis.

Table 5 Operative data and postoperative outcomes

Variable	n (%)
Type of gastrectomy
Proximal	15 (33.3)
Distal	23 (51.1)
Total	5 (11.1)
Partial	2 (4.4)
Retrieved lymph node	29.7 ± 13.7
Complications
Any	5 (11.1)
Wound infection	1 (2.2)
Postoperative bleeding	1 (2.2)
Anastomotic leakage	2 (4.4)
Abdominal infection	1 (2.2)
30-day mortality	0
Estimated blood loss (mL)	107 ± 69
Operation time (min)	180 ± 47
Time to resume soft diet (d)	5.3 ± 1.4
Time until the first flatus (d)	3.4 ± 0.8
Postoperative hospital stay (d)	9.9 ± 2.9