suzuki kazumitsu

BACKGROUND: This study aimed to investigate the laparoscopic gastrectomy (LG) performance of non-Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons under the ESSQS-qualified surgeon guidance and compare oncological outcomes of gastric cancer to LG performed by the ESSQS-qualified surgeons. METHODS: This study enrolled 1,030 patients diagnosed with both clinical and pathological stage ≤ III gastric cancer and undergoing LG from January 2009 to June 2019. ESSQS-qualified surgeons served as the operator or the instructive assistant in all LG procedures involving them. A propensity score-matched analysis was used to retrospectively compare the long-term outcomes between the ESSQS-qualified and non-ESSQS-qualified surgeons. RESULTS: Each group included 315 pairs after propensity score matching. The 3-year recurrence-free survival rates were 84.4% and 81.7% in the non-ESSQS and ESSQS groups, respectively. The difference was 2.7% (95% confidence interval: - 3.20%-8.44%, P < 0.001), and the non-ESSQS group statistically demonstrated noninferiority as the lower 95% confidence limit was greater than the prespecified margin of -10%, indicating the achieved primary endpoint. No significant differences in 5-year recurrence-free survival (non-ESSQS: 78.5% vs. ESSQS: 77.4%, P = 0.627) and 5-year overall survival (non-ESSQS: 80.9% vs. ESSQS: 79.3%, P = 0.475) were found between the two groups. The oncological outcomes stratified according to the presence of pathological stage I, II, and III disease did not significantly differ between the two groups. CONCLUSIONS: LG performed by non-ESSQS-qualified surgeons achieved comparable oncological outcomes to the ESSQS-qualified surgeons, as long as ESSQS-qualified surgeons provided intraoperative instructions, in a high-volume center.

A 49-year-old woman with no familial history of vomiting visited our hospital because of vomiting in 2014. She was admitted to our hospital for treatment for dehydration, anemia, and hypoproteinemia. Although she had been diagnosed with gastric polyposis, polyp-related anemia, and hypoproteinemia 10 years earlier, she had received only medical treatment due to rejecting surgical treatment. Following examination at admission, upper gastrointestinal endoscopy revealed gastric polyposis, which is characterized by a lump of polyps causing pyloric stenosis. We performed laparoscopic total gastrectomy to treat her repeated anemia, hypoproteinemia, and pyloric stenosis. The resected specimen consisted of polyposis located throughout the stomach. A pathological diagnosis of juvenile gastric polyposis was made. Her postoperative course was uneventful, and she showed improvement of anemia and hypoproteinemia after surgery.<BR>Juvenile gastric polyposis is thought to be rare. We successfully performed laparoscopic total gastrectomy to treat a case of juvenile gastric polyposis. Here, we report the case and review the relevant literature.