Efficacy and safety of one-step knife compared to conventional insulated-tip knife for endoscopic submucosal dissection: a preliminary study with prospective data collection and retrospective review

A single center retrospective analysis of feasibility of diagnostic endoscopic resection for grade 1 or 2 gastric neuroendocrine tumors

Currently, endoscopic resection is recommended for gastric neuroendocrine tumors (G-NETs) < 10 mm. However, a larger G-NETs can also be resected endoscopically. Here, we evaluated the feasibility of diagnostic endoscopic resection of G-NETs. We retrospectively analyzed 31 patients, diagnosed with grade 1 or 2 G-NETs at a single tertiary referral center, between January 2009 and December 2023. Outcomes analyzed included histopathology, complete resection, and metastasis rates. The mean follow-up period was 38.9 ± 38.4 months; mean size of G-NETs was 4.9 ± 3.4 mm, and the most size of G-NETs were < 10 mm (87.1%). The maximal NET diameter was 16 mm. Most NETs were grade 1 (type 1: 90.9%; type 3: 85.0%). None of the enrolled patients showed evidence of lymph node metastasis or local recurrence. Even in R1 resection (19.4%) showed no metastasis during follow-up without additional surgery. Recurrent or multiple G-NETs were observed only in patients with type 1 NETs (27.2%, 3/11). Modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) showed a 100% complete resection rate. After resection, grade 1 or 2 G-NETs had no lymph nodes or distant metastases during the follow-up period. This study suggests that G-NETs smaller than 16 mm can be considered for diagnostic endoscopic resection and this resection may be potentially definitive treatment.

Comparison of endoscopic submucosal dissection outcomes between early gastric cardiac and non-cardiac cancers: a retrospective single-center study

OBJECTIVES

This study aims to compare the efficacy of endoscopic submucosal dissection (ESD) between early gastric cardiac cancer (EGCC) and early gastric non-cardiac cancer (EGNCC), and investigate associated risk factors for non-curative resection.

METHODS

Early gastric cancer (EGC) patients who underwent ESD from January 2015 to September 2020 in Beijing Friendship Hospital were consecutively enrolled. The clinical, histopathological and endoscopic data were retrospectively analyzed. The study was registered in Chinese Clinical Trial Registry (ChiCTR1800017117).

RESULTS

Among 500 patients with 534 EGC lesions, 117 patients with 118 lesions were allocated to the EGCC group, and 383 patients with 416 lesions to the EGNCC group. The rates of en bloc resection, complete resection and curative resection in the EGCC group were 97.5%, 78.8% and 71.2%, respectively, significantly lower than those in the EGNCC group (99.8%, 94.5% and 90.4%, p = .010, <.001 and <.001). Among non-curative resected lesions, EGCC had more cases in both endoscopic curability (eCura) C-1 and C-2 groups than EGNCC (10.2% and 18.6% vs. 2.4% and 7.2%, p < .001). Multivariate analysis showed that tumor size (OR 2.393, 95% CI 1.388-4.126) and submucosal invasion (OR 11.498, 95% CI 3.759-35.175) were risk factors for non-curative resection in the EGCC group. For EGCC larger than 3 cm, none achieved curative resection, 86.7% were classified as eCura C-2 and 46.7% exhibited deep submucosal infiltration.

CONCLUSIONS

The curative resection rate of ESD for EGCC was lower than that for EGNCC. ESD for EGCC larger than 3 cm should be cautiously considered.

Which one is better? Laparoscopic versus robotic reconstruction in the remnant soft pancreas with a small pancreatic duct following pancreaticoduodenectomy: a multicenter study with propensity score matching analysis

BACKGROUND

Evidence of the advantages of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) is limited. Thus, this study aimed to compare the surgical outcomes of laparoscopic reconstruction L-recon) versus robotic reconstruction (R-recon) in patients with soft pancreas and small pancreatic duct.

METHOD

Among 429 patients treated with minimally invasive pancreaticoduodenectomy (MIPD) between October 2012 and June 2020 by three surgeons at three institutions, 201 patients with a soft pancreas and a small pancreatic duct (< 3 mm) were included in this study.

RESULTS

Sixty pairs of patients who underwent L-recon and R-recon were selected after propensity score matching. The perioperative outcomes were comparable between the reconstruction approaches, with comparable clinically relevant postoperative pancreatic fistula (CR-POPF) rates (15.0% [L-recon] vs. 13.3% [R-recon]). The sub-analysis according to the type of MIPD procedure also showed comparable outcomes, but only a significant difference in postoperative hospital stay was identified. During the learning curve analysis using the cumulative summation by operation time (CUSUM_OT), two surgeons who performed both L-recon and R-recon procedures reached their first peak in the CUSUM_OT graph earlier for the R-recon group than for the L-recon group (i.e., 20th L-recon case and third R-recon case of surgeon A and 43rd L-recon case and seventh R-recon case of surgeon B). Surgeon C, who only performed R-recon, demonstrated the first peak in the 22nd case. The multivariate regression analysis for risk factors of CR-POPF showed that the MIPD procedure type, as well as other factors, did not have any significant effect.

CONCLUSION

Postoperative pancreatic fistula rates and the overall perioperative outcomes of L-recon and R-recon were comparable in patients with soft-textured pancreas and small pancreatic duct treated by experienced surgeons.