Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2023; 15(1): 94-104
Published online Jan 27, 2023. doi: 10.4240/wjgs.v15.i1.94
Associate factors for endoscopic submucosal dissection operation time and postoperative delayed hemorrhage of early gastric cancer
Ren-Song Cai, Wei-Zhong Yang, Guang-Rui Cui
Ren-Song Cai, Wei-Zhong Yang, Guang-Rui Cui, Digestive Endoscopy Department, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
Author contributions: Cai RS designed this study, analyzed the data and drafted the manuscript; Yang WZ and Cui GR collected the data and reviewed the manuscript critically; all authors have read and approved the final manuscript version.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of the Second Affiliated Hospital of Hainan Medical University.
Informed consent statement: The data used in this study were not involved in the patients’ privacy information, so the informed consent was waived by the Ethics Committee of Second Affiliated Hospital of Hainan Medical University. All patient data obtained, recorded, and managed only used for this study, and all patient information are strictly confidential, without any harm to the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ren-Song Cai, BSc, MD, Attending Doctor, Digestive Endoscopy Department, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Avenue, Longhua District, Haikou 570311, Hainan Province, China. cairensong@126.com
Received: November 14, 2022
Peer-review started: November 14, 2022
First decision: December 1, 2022
Revised: December 6, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 27, 2023
Processing time: 65 Days and 5.4 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) is a treatment for early gastric cancer with the advantages of small invasion, fewer complications, and a low local recurrence rate. However, there is a high risk of complications such as bleeding and perforation, and the operation time is also longer. ESD operation time is closely related to bleeding and perforation.

AIM

To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning, early identification, and prevention of complications.

METHODS

We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021. The baseline data, clinical features, and endoscopic and pathological characteristics of patients were collected. The multivariate linear regression model was used to investigate the influencing factors of ESD operation time. Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.

RESULTS

The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815% of ESD operation time when other influencing factors remained unchanged. The operation time increased by 3.766% or 10.247% if the lesion was mixed or concave. The operation time increased by 4.417% if combined with an ulcer or scar. The operation time increased by 3.692% if combined with perforation. If infiltrated into the submucosa, it increased by 2.536%. Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion, lesion morphology, and ESD operation time were independent influencing factors for delayed hemorrhage after ESD. Patients with lesion ≥ 3.0 cm (OR = 3.785, 95%CI: 1.165-4.277), lesion morphology-concave (OR = 10.985, 95%CI: 2.133-35.381), and ESD operation time ≥ 60 min (OR = 2.958, 95%CI: 1.117-3.526) were prone to delayed hemorrhage after ESD.

CONCLUSION

If the maximum diameter of the lesion in patients with early gastric cancer is ≥ 3.0 cm, and the shape of the lesion is concave, or accompanied by an ulcer or scar, combined with perforation, and infiltrates into the submucosa, the ESD operation will take a longer time. When the maximum diameter of the lesion is ≥ 3.0 cm, the shape of the lesion is concave in patients and the operation time of ESD takes longer time, the risk of delayed hemorrhage after ESD is higher.

Keywords: Early gastric cancer; Endoscopic submucosal dissection; Operation time; Delayed hemorrhage

Core Tip: Gastric cancer is a common malignant tumor of the digestive system worldwide. Endoscopic submucosal dissection (ESD) is the first-line treatment for early gastric cancer. However, the long operation time of ESD and its postoperative delayed hemorrhage are the major complications, which can cause more severe cardiovascular complications, such as bradycardia and hypotension. In this retrospective analysis study, the risk factors of long operation time and postoperative delayed hemorrhage were studied. Lesion diameter and shape, ulcer or scar, perforation, and invasion depth all affected the operation time, and lesion diameter, lesion shape, and ESD operation time were independent factors for the occurrence of delayed hemorrhage after ESD.