Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The treatment options for gastrointestinal stromal tumors (GITSs) at the esophagogastric junction (EGJ) are controversial. There have been reports on enucleation for EGJ GISTs in order to avoid gastrectomy. But the number of patients is too small, or the follow-up period is too short to evaluate it. The purpose of this study was to review our experience of 59 patients with EGJ GISTs treated by enucleation by percutaneous endoscopic intragastric surgery (PEIGS) and assess the clinical outcomes.

Methods

PEIGS is performed as described below. Access ports are placed through the abdominal wall and the anterior wall of the stomach. Through the access ports, an endoscope and surgical instruments are inserted into the gastric lumen and tumor enucleation and closure of the defect are carried out. In this study, 59 patients with EGJ GISTs treated by PEIGS between 2005 and 2013 were enrolled. Their hospital records were reviewed, and follow-up data for 8 years were collected to analyze the outcomes.

Results

En-bloc enucleation was achieved without tumor rupture in all. Average operation time was 172.3 min. Postoperative complications occurred in 3 (one localized peritonitis, one bleeding, and one surgical site infection). Average tumor size was 35.6 mm. Pathological findings confirmed negative margin in all specimens. The maximum follow-up period was 101 months. Multiple liver metastases were detected in two patients (at 12 and 29 months). The survival rate was 100 %. The disease-free rate was 98.3 % at 12 months and 96.6 % at 29 months, respectively.

Conclusions

As far as the short- and long-term outcomes of our experience are reviewed, PEIGS seems as curative as other aggressive resection methods such as proximal gastrectomy. Tumor enucleation by PEIGS, offering a chance to preserve the stomach, can be a preferable option in carefully selected patients with EGJ GISTs, when performed by a skilled surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Abraham SC, Krasinskas AM, Hofstetter WL et al (2007) “Seedling” mesenchymal tumors (gastrointestinal stromal tumors and leiomyomas) are common incidental tumors of the esophagogastric junction. Am J Surg Pathol 31(11):1629–1635

    Article  PubMed  Google Scholar 

  2. Peparini N, Carbotta G, Chirletti P (2011) Enucleation for gastrointestinal stromal tumors at the esophagogastric junction: is this an adequate solution? World J Gastroenterol 17:2159–2160

    Article  PubMed  PubMed Central  Google Scholar 

  3. Coccolini F, Catena F, Ansaloni L et al (2010) Esophagogastric junction gastrointestinal stromal tumor: resection vs enucleation. World J Gastroenterol 16:4374–4376

    Article  PubMed  PubMed Central  Google Scholar 

  4. Blay JY, Bonvalot S, Casali P et al (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16(4):566–578

    Article  PubMed  Google Scholar 

  5. Demetri GD, Benjamin RS, Blanke CD et al (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5(Suppl 2):S1–S29

    PubMed  Google Scholar 

  6. Everett M, Gutman H (2008) Surgical management of gastrointestinal stromal tumors: analysis of outcome with respect to surgical margins and technique. J Surg Oncol 98(8):588–593

    Article  PubMed  Google Scholar 

  7. Ohashi S (1995) Laparoscopic intraluminal (intragastric) surgery for early gastric cancer. A new concept in laparoscopic surgery. Surg Endosc 9(2):169–171

    Article  CAS  PubMed  Google Scholar 

  8. Ohgami M, Otani Y, Kumai K et al (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23(2):187–193

    Article  CAS  PubMed  Google Scholar 

  9. Kanehira E, Omura K, Wakasa E et al (1998) A technique of percutaneous endoscopic intragastric surgery. Minim Invasive Ther Allied Technol 7(1):15–20

    Article  Google Scholar 

  10. Kanehira E, Kamei A, Tanida T (2014) Wedge gastric and endo-gastric resection. In: Mori T, Dapri G (eds) Reduced port laparoscopic surgery. Springer, Tokyo, pp 221–231

    Google Scholar 

  11. Nishida T, Hirota S, Yanagisawa A et al (2008) Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 13(5):416–430

    Article  PubMed  Google Scholar 

  12. Kanehira E, Siozawa K, Kamei A, Tanida T (2014) Development of a novel multichannel port (x-Gate®) for reduced port surgery and its initial clinical results. Minim Invasive Ther Allied Technol 21(1):26–30

    Article  Google Scholar 

  13. Barajas-Gamboa JS, Acosta G, Savides TJ et al (2015) Laparo-endoscopic transgastric resection of gastric submucosal tumors. Surg Endosc 29(8):2149–2157

    Article  PubMed  Google Scholar 

  14. Lai DT, Chu KM, Storey DW (1996) Laparoscopic endoluminal gastric surgery. Aust N Z J Surg 66(1):41–42

    Article  CAS  PubMed  Google Scholar 

  15. Shim JH, Lee HH, Yoo HM et al (2011) Intragastric approach for submucosal tumors located near the Z-line: a hybrid laparoscopic and endoscopic technique. J Surg Oncol 104(3):312–315

    Article  PubMed  Google Scholar 

  16. Na JU, Lee SI, Noh SM (2011) The single incision laparoscopic intragastric wedge resection of gastric submucosal tumor. J Gastric Cancer 11(4):225–229

    Article  PubMed  PubMed Central  Google Scholar 

  17. Conrad C, Nedelcu M, Ogiso S, Aloia TA, Vauthey JN, Gayet B (2014) Techniques of intragastric laparoscopic surgery. Surg Endosc 29(1):202–206

    Article  PubMed  Google Scholar 

  18. Song KY, Kim SN, Park CH (2007) Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction. Surg Endosc 21(12):2272–2276

    Article  PubMed  Google Scholar 

  19. Hiki N, Yamamoto Y, Fukunaga T et al (2008) Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 22(7):1729–1735

    Article  CAS  PubMed  Google Scholar 

  20. Valle M, Federici O, Carboni F et al (2013) Gastrointestinal stromal tumors of the stomach: the role of laparoscopic resection. Single-centre experience of 38 cases. Surg Endosc 28(3):1040–1047

    Article  PubMed  Google Scholar 

  21. Hsiao CY, Yang CY, Lai IR et al (2014) Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results. Surg Endosc 29(4):868–873

    Article  PubMed  Google Scholar 

  22. Kim KH, Kim MC, Jung GJ et al (2012) Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible? World J Surg Oncol 10:230

    Article  PubMed  PubMed Central  Google Scholar 

  23. Matsuhashi N, Osada S, Yamaguchi K et al (2013) Long-term outcomes of treatment of gastric gastrointestinal stromal tumor by laparoscopic surgery: review of the literature and our experience. Hepatogastroenterology 60(128):2011–2015

    PubMed  Google Scholar 

  24. De Vogelaere K, Hoorens A, Haentjens P, Delvaux G (2013) Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc 27(5):1546–1554

    Article  PubMed  Google Scholar 

  25. Photi ES, Igali L, Cheong EC et al (2014) Long-term outcomes and recurrence patterns in upper gastrointestinal tract gastrointestinal stromal tumours (GISTs) treated by minimally invasive surgery. Dig Surg 31(3):185–189

    Article  CAS  PubMed  Google Scholar 

  26. Masoni L, Gentili I, Maglio R et al (2014) Laparoscopic resection of large gastric GISTs: feasibility and long-term results. Surg Endosc 28(10):2905–2910

    Article  PubMed  Google Scholar 

  27. Hwang JC, Kim JH, Kim JH et al (2009) Endoscopic resection for the treatment of gastric subepithelial tumors originated from the muscularis propria layer. Hepatogastroenterology 56(94–95):1281–1286

    PubMed  Google Scholar 

  28. Li QL, Yao LQ, Zhou PH et al (2012) Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection. Gastrointest Endosc 75(6):1153–1158

    Article  PubMed  Google Scholar 

  29. Kim HH (2015) Endoscopic treatment for gastrointestinal stromal tumor: advantages and hurdles. World J Gastrointest Endosc 7(3):192–205

    Article  PubMed  PubMed Central  Google Scholar 

  30. Portale G, Zaninotto G, Costantini M et al (2007) Esophageal GIST: case report of surgical enucleation and update on current diagnostic and therapeutic options. Int J Surg Pathol 15(4):393–396

    Article  PubMed  Google Scholar 

  31. Nawara C, Augschöll C, Hutter J et al (2013) Oesophageal GIST at the left tracheobronchial angle: resection with right-sided VATS. Zentralbl Chir 138(5):499–501

    Article  CAS  PubMed  Google Scholar 

  32. Isaka T, Kanzaki M, Onuki T (2015) Long-term survival after thoracoscopic enucleation of a gastrointestinal stromal tumor arising from the esophagus. J Surg Case Rep. doi:10.1093/jscr/rju155

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Medical Topia Soka, 1-11-18, Yatsuka, Soka-City, Saitama, 3400028, Japan

    Eiji Kanehira, Aya Kamei, Takashi Tanida & Masafumi Nakagi

  2. Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan

    Akiko Umezawa

  3. Department of Surgery, Ageo Central General Hospital, Saitama, Japan

    Atsushi Kurita

Authors
  1. Eiji Kanehira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aya Kamei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akiko Umezawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsushi Kurita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Tanida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masafumi Nakagi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiji Kanehira.

Ethics declarations

Disclosures

Eiji Kanehira, Aya Kamei, Akiko Umezawa, Atsushi Kurita, Takashi Tanida, and Masafumi Nakagi have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kanehira, E., Kamei, A., Umezawa, A. et al. Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction. Surg Endosc 30, 2036–2042 (2016). https://doi.org/10.1007/s00464-015-4439-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4439-8

Keywords

Search

Navigation