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Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size

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Abstract

Background

Feasibility and long-term safety of laparoscopic removal of gastric gastrointestinal stromal tumors (GISTs) of the stomach is well established for lesions smaller than 2 cm. Our specific aim was to explore whether laparoscopic treatment is equally applicable for gastric GISTs larger than 2 cm.

Methods

Between 1997 and 2010, 31 consecutive patients presenting with a primary gastric GIST were scheduled for laparoscopic resection, irrespective of tumor size. Prerequisites for laparoscopic approach were the absence of metastases and the presence of a well-defined tumor on CT scanning without involvement of adjacent organs, the esophagogastric junction, or the pylorus of the stomach. Data were retrieved retrospectively from a prospectively collected database, including information on patient demographics, surgical procedure, complications, hospital stay, and recurrence. Diagnosis of GIST was based on microscopic analysis, including immunohistochemistry with a panel of antibodies: CD117, CD34, DOG1, S100, desmin, and smooth muscle actin.

Results

All 31 laparoscopic resections were carried out successfully. The most common symptoms were melena, anemia, and abdominal pain. In one case we performed a laparoscopic approach for a GIST with acute bleeding. Tumor size was smaller than 2 cm in 5 patients and larger than 2 cm in 26 patients. The median tumor size was 4.4 cm (range = 0.4–11.0 cm). Median blood loss was identical in both groups (20 ml), but duration of operation (60 vs. 103 min) and duration of hospital stay (6 vs. 8 days) were lower when tumor size was less than 2 cm. Only one patient (with tumor size <2 cm) experienced a postoperative hemorrhage. After a median follow-up of 52 months, there were no recurrences or metastases.

Conclusion

The low morbidity rates and the long-term disease-free interval of 100% observed in our cohort indicate that laparoscopic resection is safe and effective in treating gastric GISTs, even for tumors larger than 2 cm.

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Disclosures

Drs. De Vogelaere, Van Loo, Peeters, Hoorens, Haentjens, and Delvaux have no commercial association that might create a conflict of interest in connection with any of the products mentioned in this article.

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Authors and Affiliations

  1. Department of Abdominal Surgery, Universitair Ziekenhuis Brussel, Jette, Brussel, Belgium

    K. De Vogelaere, I. Van Loo, P. Haentjens & G. Delvaux

  2. Department of Gastroenterology, Deurne, Belgium

    O. Peters

  3. Department of Pathology, Universitair Ziekenhuis Brussel, Jette, Brussel, Belgium

    A. Hoorens

  4. Department of Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090, Brussel, Belgium

    K. De Vogelaere

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  1. K. De Vogelaere
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  2. I. Van Loo
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  3. O. Peters
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  4. A. Hoorens
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  5. P. Haentjens
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  6. G. Delvaux
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Correspondence to K. De Vogelaere.

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De Vogelaere, K., Van Loo, I., Peters, O. et al. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc 26, 2339–2345 (2012). https://doi.org/10.1007/s00464-012-2186-7

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  • DOI: https://doi.org/10.1007/s00464-012-2186-7

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