A Promising Method for Tumor Localization during Total Laparoscopic Distal Gastrectomy: Preoperative Endoscopic Clipping based on Negative Biopsy and Selective Intraoperative Radiography Findings

정주원; 서경원; 정경원; 박무인; 김성은; 박선자; 이상호

doi:https://doi.org/10.5230/jgc.2017.17.e25

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자료유형: 학술저널

저자정보: 정주원 (고신대학교) 서경원 (고신대학교) 정경원 (고신대학교) 박무인 (고신대학교) 김성은 (고신대학교) 박선자 (고신대학교) 이상호 (고신대학교)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제17권 제3호

발행연도: 2017.9

수록면: 220 - 227 (8page)

DOI: https://doi.org/10.5230/jgc.2017.17.e25

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연구방법

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Purpose: Precise localization of tumors and creation of sufficient proximal resection margins are complicated processes during total laparoscopic distal gastrectomy (TLDG) for clinical T1/T2 gastric cancers. Various solutions to this problem have also yielded many disadvantages. In this study, we reviewed a preoperative endoscopic clipping method based on the results of negative biopsy and selective intraoperative radiography. Materials and Methods: A retrospective review of 345 consecutive patients who underwent TLDG and preoperative endoscopic clipping for tumor localization was conducted. During preoperative endoscopy, the endoscopists performed negative biopsies just 1?2 cm selectively above the tumor's upper limit. After confirming the biopsy results, endoscopic metal clips were applied just proximal to the negative biopsy site the day before surgery. Selective intraoperative tumor localization using portable abdominal radiography was performed only when we could not ensure a precise resection line. Results: Negative biopsy was performed in 244 patients. Larger tumor size (P=0.008) and more distally located tumors (P=0.052) were observed more frequently in the negative biopsy group than in the non-negative biopsy group. The non-negative biopsy group had significantly higher frequencies of differentiated tumor types than the negative biopsy group (P=0.003). Of the 244 patients who underwent negative biopsies, 6 had cancer cells in their biopsy specimens. We performed intraoperative radiography in 12 patients whose tumors had difficult-to-determine proximal margins. No tumors were found in the proximal resection margins of any patients. Conclusions: Our tumor localization method is a promising and accurate method for securing a sufficient resection margin during TLDG.

#Stomach neoplasms #Laparoscopy #Gastrectomy #Tumor localization #Negative biopsy

참고문헌 (10)

참고문헌 신청

Kim MG / 2011 / A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients(body mass index≥30) / World J Surg 35:1327~1332

Kim HI / 2011 / Intraoperative portable abdominal radiograph for tumor localization : a simple and accurate method for laparoscopic gastrectomy / Surg Endosc 25:958~963

Xuan Y / 2013 / Efficacy of intraoperative gastroscopy for tumor localization in totally laparoscopic distal gastrectomy for cancer in the middle third of the stomach / Surg Endosc 27:4364~4370

정상호 / 2013 / Effectiveness of endoscopic clipping and computed tomography gastroscopy for the preoperative localization of gastric cancer / 대한외과학회지 84(2):80~87

Japanese Gastric Cancer Association / 2017 / Japanese gastric cancer treatment guidelines 2014 (ver. 4) / Gastric Cancer 20:1~19

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