The feasibility of additional minimally invasive gastrectomy after non-curative endoscopic submucosal dissection of esophagogastric junction cancer

Background Patients with esophagogastric junction (EGJ) cancer who undergo non-curative endoscopic submucosal dissection (ESD) typically require additional surgical treatment. However, the impact of prior ESD on the safety of subsequent gastrectomy for EGJ cancer remains unclear. Methods Clinical data from 110 patients who underwent gastrectomy for EGJ cancer at Ishikawa Prefectural Central Hospital between January 2008 to December 2023 were retrospectively analyzed. Of these 110 patients, 47 had previously undergone non-curative ESD (ESD (+) group), while the remaining 63 underwent primary gastrectomy without prior ESD (ESD (−) group). Patient characteristics, operative data, and postoperative complications were compared between the two groups. Risk factors associated with postoperative complications were also evaluated. Results Patient backgrounds, operative procedures, and surgical approaches were comparable between the two groups. The amount of blood loss was significantly higher in the ESD (+) group than in the ESD (−) group (49.4 vs. 30.2 ml, P = 0.025). The postoperative complication rate was similar in both groups (14.8% vs. 12.7%, respectively; P = 0.740). Lower mediastinal lymphadenectomy and longer operation time were associated with a higher risk of postoperative complications ( P = 0.041 and P = 0.001). Conclusion Additional gastrectomy following non-curative ESD did not adversely affect the short-term outcomes in patients with EGJ cancer. Additional gastrectomy after ESD may be safe and feasible for early EGJ cancer.