Timing of additional laparoscopic surgery after non-curative endoscopic treatment for early gastric cancer and risk factors for postoperative complications
LIU Hao
TANG Zhao-qing
LI Hao-jie
SHEN Zhen-bin
ZHANG Yi-qun
GAO Xiao-dong
ZHANG Heng
WANG Xue-fei
SUN Yi-hong
Abstract：Objective To explore the impact of different surgical timing for additional laparoscopic surgery after non-curative ESD for early gastric cancer on surgical safety,as well as the risk factors that can be identified before surgery and affect the postoperative complication rate.Methods A retrospective collection of clinical and pathological data was conducted on 74 patients with early gastric cancer who underwent non-curative endoscopic treatment followed by additional laparoscopic surgery at Zhongshan Hospital,Fudan University,between June 2013 and December 2021.The incidence of postoperative complications at different surgical times and the results of laboratory tests before surgery were analyzed.Results The incidence of postoperative complications in the early surgery group(surgery interval≤33 days)was 41.3％,significantly higher than that in the delayed surgery group(3.6％,P＜0.001).Patients with postoperative complications undergoing additional surgery had an average of(20.8±16.9)days after endoscopic treatment,significantly earlier than patients without postoperative complications[(39.0±27.8)days,P=0.001];The preoperative plasma prealbumin level in patients with postoperative complications was(0.210±0.065)g/L,significantly lower than that in patients without postoperative complications[(0.242±0.058)g/L,P=0.041].There was also a significant statistical difference in the fibrinogen/albumin ratio index(FARI)between the two groups of patients(8.48±2.06)in the group with complications and(6.73±1.84)in the group without complications,P=0.001).Early additional surgery,high FARI,and low preoperative plasma prealbumin level are related to postoperative complications of additional laparoscopic surgery after ESD while only early additional surgery is an independent risk factor.Conclusion Additional laparoscopic surgery should be performed with standard laparoscopic examination to confirm that the local inflammatory response has subsided at least five weeks,preferably eight weeks after ESD.
Keywords：early gastric cancernon-curative endoscopic treatmentadditional laparoscopic surgerypostoperative complication
Publication Date：2024-06-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 674-679 )