Journal of Gastrointestinal Surgery

, Volume 17, Issue 2, pp 244–256

Predictors of Unsuccessful Laparoscopic Resection of Gastric Submucosal Neoplasms

  • Sabha Ganai
  • Vivek N. Prachand
  • Mitchell C. Posner
  • John C. Alverdy
  • Eugene Choi
  • Mustafa Hussain
  • Irving Waxman
  • Marco G. Patti
  • Kevin K. Roggin
2012 SSAT Plenary Presentation

DOI: 10.1007/s11605-012-2095-z

Cite this article as:
Ganai, S., Prachand, V.N., Posner, M.C. et al. J Gastrointest Surg (2013) 17: 244. doi:10.1007/s11605-012-2095-z

Abstract

Background

While laparoscopy has become integral to the performance of foregut surgery, its optimal use in resection of gastric submucosal neoplasms, including gastrointestinal stromal tumors (GISTs), remains uncertain. Concern exists for technical feasibility related to tumor size and location, as well as oncologic outcome.

Methods

From 2002 to 2012, 106 patients underwent resection for gastric submucosal neoplasms, comprising 79 laparoscopic and 27 open resections. Median follow-up was 15 months.

Results

Patients were 62 ± 14 years and 56 % male. Mean tumor size was 5.5 ± 4.3 cm, with 76 % being GISTs. A total of 8 (10 %) conversions occurred in the laparoscopic cohort. On multivariate analysis, conversion was predicted by size greater than 8 cm, while recurrence was predicted by mitotic index (p < 0.05). Laparoscopic resection resulted in better perioperative outcomes, with less morbidity, operative time, blood loss, and length of stay (p < 0.05). No significant difference was seen in survival, with 90 % and 81 % alive 3 years after laparoscopic and open resection, respectively (HR 0.4; 95 % CI 0.1–1.3; p = 0.13).

Conclusions

Laparoscopic resection is feasible and effective in the management of gastric submucosal neoplasms, including GISTs. Caution should be reserved for tumors greater than 8 cm. Oncologic outcome appears to be predicted by tumor biology as opposed to surgical approach.

Keywords

LaparoscopyGastric neoplasmGISTSubmucosal tumors

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Sabha Ganai
    • 1
  • Vivek N. Prachand
    • 1
  • Mitchell C. Posner
    • 1
  • John C. Alverdy
    • 1
  • Eugene Choi
    • 1
  • Mustafa Hussain
    • 1
  • Irving Waxman
    • 2
  • Marco G. Patti
    • 1
  • Kevin K. Roggin
    • 1
    • 3
  1. 1.Department of SurgeryThe University of Chicago Medical CenterChicagoUSA
  2. 2.Center for Endoscopic Research and TherapeuticsThe University of Chicago Medical CenterChicagoUSA
  3. 3.The University of Chicago MedicineChicagoUSA