Long-term outcomes of combination of endoscopic submucosal dissection and laparoscopic lymph node dissection without gastrectomy for early gastric cancer patients who have a potential risk of lymph node metastasis

Background: Our recently developed procedure, a combination of endoscopic submucosal dissection (ESD) and laparoscopic lymph node dissection (LLND), may lead to the elimination of unnecessary gastrectomy in early gastric cancer (EGC) patients having a potential risk of lymph node metastasis (LNM). Objective: To examine the long-term outcomes of the combination of ESD and LLND. Design: A retrospective study using consecutive data. Setting: Single academic center. Patients and Interventions: Twenty-one EGC patients having a potential risk of LNM were treated by ESD followed by LLND. Main Outcome Measurements: Long-term outcomes of the combination of ESD and LLND. Results: The histopathological examination of the dissected lymph nodes confirmed the absence of LNM in 19 of the 21 patients. Two patients who had LNM were followed without any additional surgery in accordance with the patients' wishes. During the median follow-up of 61 months, all of the patients were alive without any recurrent disease. Two patients (10%) had symptoms such as abdominal distention and belching, which were associated with disturbed gastric emptying between meals. Endoscopic examination 2 years postoperatively revealed food residue problems in 3 patients (15%). However, the preoperative quality of life was restored with no dietary restrictions, and body weight was well maintained in all of the patients. Limitations: A retrospective study with a small number of patients. Conclusions: The combination of ESD and LLND can be an effective, minimally invasive treatment that maintains long-term quality of life for selected EGC patients having a potential risk of LNM. (Gastrointest Endosc 2011;74:792-7.)