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Laparoscopic vs open resection of gastric stromal tumors

  • B. D. Matthews
  • R. M. Walsh
  • K. W. Kercher
  • R. F. Sing
  • B. L. Pratt
  • G. A. Answini
  • B. T. Heniford
Original Articles

Abstract

Background

Gastric stromal tumors are rare neoplasms that may be benign or malignant. Given that malignant gastric stromal tumors rarely involve lymph nodes and require excision with negative margins, they appear amendable to laparoscopic excision. There are few reports of laparoscopic resection, and no comparisons have been done between laparoscopic and open surgery. This study compares the relative efficacy of the two approaches.

Methods

Between May 1994 and December 2000, 33 patients underwent 35 operations for gastric stromal tumors. Laparoscopic resections were performed in 21 patients; open resections were done in 12 patients. The medical records of the patients were reviewed retrospectively with regard to operating time, blood loss, length of stay, and clinical course.

Results

Patient demographics, tumor characteristics (mean tumor size, benign vs malignant), and presenting symptoms were similar for both groups. In the laparoscopic group, 15 wedge resections; three partial gastrectomies, and three transgastric needlescopic enucleations were performed. In the open group, six vedge resections, four antrectomies, and two partial proximal gastrectomies were performed. There were no significant differences in mean operative time (169 vs 160 min), mean estimated blood loss (106 vs 129 cc), or perioperative complication rate (9.5% vs 8.3%) between the laparoscopic and open groups, respectively. The mean length of stay was significantly less (p<0.05) in the laparoscopic group (3.8 vs 6.2 days). Average follow-up was 1.5 years. One patient in each group has died due to metastastic disease. There have been no trocar site recurrences.

Conclusions

Laparoscopic resection of gastric stromal tumors is safe and appropriate. Tumor size, operating time, and estimated blood loss were equivalent to the open approach, and there was a statistically shorter hospital stay in the laparoscopic group.

Key words

Gastric surgery Stromal tumors Laparoscopy Flexible endoscopy Stomach 

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References

  1. 1.
    Barbosa J, Maciel J, Amarante M (1995) Endoscopic ultrasonography in the study of extramucosal swellings in the upper digestive tract. Surg Endosc 9: 1193–1196PubMedCrossRefGoogle Scholar
  2. 2.
    Basso N, Rosato P, De Leo T, Picconi T, Trentino P, Fantini A, Silecchia G (2000) Laparoscopic treatment of gastric stromal tumors. Surg Endosc 14: 524–526PubMedCrossRefGoogle Scholar
  3. 3.
    Buyske J, McDonald M, Fernandez C, Munson JL, Sanders LE, Tsao J, Birkett DH (1997) Minimally invasive management of low-grade and benign gastric tumors. Surg Endosc 11: 1084–1087PubMedCrossRefGoogle Scholar
  4. 4.
    Conlon KC, Casper ES, Brennen MF (1995) Primary gastrointestinal sarcomas: analysis of prognostic variables. Ann Surg Oncol 2: 26–31PubMedCrossRefGoogle Scholar
  5. 5.
    Cuschieri A (2000) Laparoscopic gastric resection. Surg Clin North Am 80: 1269–1284PubMedCrossRefGoogle Scholar
  6. 6.
    DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231: 51–58PubMedCrossRefGoogle Scholar
  7. 7.
    Erlandson RA, Klimstra DS, Woodruff JM (1996) Subclassification of gastrointestinal stromal tumors based on evaluation by electron microscopy and immunohistochemistry. Ultrastruct Pathol 20: 373–393PubMedCrossRefGoogle Scholar
  8. 8.
    Ernst T, Hubbs A, Przygodzki R, Emory T, Sobin L, O’Leary T (1998) KIT mutation portends poor prognosis in gastrointestinal stromal/smooth muscle tumors. Lab Invest 78: 1633–1666PubMedGoogle Scholar
  9. 9.
    Franquemont DW (1995) Differentiation and risk assessment of gastrointestinal stromal tumors. Am J Clin Pathol 103: 41–47PubMedGoogle Scholar
  10. 10.
    Fukasawa T, Chong JM, Sakurai S, Koshiishi N, Ikeno R, Tanaka A, Matsumoto H, Hayashi Y, Koike M, Fukayama M (2000) Allelic loss of 14q and 22q, NF2 mutation, and genetic instability occurs independently of c-kit mutation in gastrointestinal stromal tumors. Jpn J Cancer Res 91: 1241–1249PubMedGoogle Scholar
  11. 11.
    Geis WP, Baxt R, Kim HC (1996) Benign gastric tumors minimally invasive approach. Surg Endosc 10: 407–410PubMedCrossRefGoogle Scholar
  12. 12.
    Graadt van Roggen JF, van Velthuysen MLF, Hogendoorn PCW (2001) The histopathological differential diagnosis of gastrointestinal stromal tumors. J Clin Pathol 54: 96–103PubMedCrossRefGoogle Scholar
  13. 13.
    Gurbuz AT, Peetz ME (1997) Resection of a gastric leiomyoma using combined laparoscopic approach. Surg Endosc 11: 285–286PubMedCrossRefGoogle Scholar
  14. 14.
    Heniford BT, Area MJ, Walsh RM (2000) The mini-laparoscopic intragastric resection of a gastrointestinal stromal tumor: a novel approach. Surg Laparosc Endosc Percutan Tech 10: 82–85PubMedCrossRefGoogle Scholar
  15. 15.
    Hirota S, Isozaki K, Moriyama Y (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279: 577–580PubMedCrossRefGoogle Scholar
  16. 16.
    Kim CJ, Day S, Yeh KA (2001) Gastrointestinal stromal tumors: analysis of clinical and pathologic factors. Am Surg 67: 135–137PubMedGoogle Scholar
  17. 17.
    Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM (1998) Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumor shows phenotypic characteristics of the interstitial cell of Cajal. Am J Pathol 152: 1259–1269PubMedGoogle Scholar
  18. 18.
    Knoop M, St Friedrichs K, Dierschke J (2000) Surgical management of gastrointestinal stromal tumors of the stomach. Langenbecks Arch Surg 385: 194–198PubMedCrossRefGoogle Scholar
  19. 19.
    Ludwig DJ, Traverse LW (1997) Gut stromal tumors and their clinical behavior. Am J Surg 173: 390–394PubMedCrossRefGoogle Scholar
  20. 20.
    Miettinen M, Sarlomo-Rikala M, Lasota J (1998) Gastrointestinal stromal tumors. Ann Chirurg Gynaeol 87: 278–281Google Scholar
  21. 21.
    Miettinen M, Sarlomo-Rikala M, Lasota J (1999) Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 30: 1213–1220PubMedCrossRefGoogle Scholar
  22. 22.
    Miettinen M, Virolainen M, Sarlomo-Rikala M (1995) Gastrointestinal stromal tumors—value of CD 34 antigen in their identification and separation from true leiomyomas and schwannomas. Am J Surg Pathol 19: 207–216PubMedCrossRefGoogle Scholar
  23. 23.
    Nishida T, Nakamura J, Taniguchi M, Hirota S, Ito T, Kitamura Y, Matsuda H (2000) Clinicopathological features of gastric stromal tumors. J Exp Clin Cancer Res 19: 417–425PubMedGoogle Scholar
  24. 24.
    Otani Y, Ohgami M, Igarashi N, Kimata M, Kubota T, Kumai K, Kitajima M, Mukai M (2000) Laparoscopic wedge resection of gastric submucosal tumors. Surg Laparosc Endosc Percutan Tech 10: 19–23PubMedCrossRefGoogle Scholar
  25. 25.
    Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Onco 17: 705–712CrossRefGoogle Scholar
  26. 26.
    Sakurai S, Fukasawa T, Chong JM, Tanaka A, Fukayama M (1999) Embryonic form of smooth muscle myosin heavy chain (Smemb/MHC) in gastrointestinal stromal tumor and interstitial cells of Cajal. Am J Pathol 154: 23–28PubMedGoogle Scholar
  27. 27.
    Sanders L, Silverman M, Rossi R, Braasch J, Munson L (1996) Gastric smooth muscle tumors: diagnostic dilemmas and factors affecting outcome. World J Surg 20: 992–995PubMedCrossRefGoogle Scholar
  28. 28.
    Tangoku A, Yamamoto K, Hirazawa K, Takao T, Mori N, Tada K, Oka M (1999) Laparoscopic resection of large leiomyomas of the gastric fundus. Surg Endosc 13: 1050–1052PubMedCrossRefGoogle Scholar
  29. 29.
    Ueyama T, Lawamoto K, Iwashita I, Masuda K, Haraguchi Y, Oiwa T, Yoshida M, Utsunomiya T (1995) Correlation between tumor volume doubling time and histologic findings in gastric smooth muscle tumors: clinical implications of tumor volume doubling time. J Surg Oncol 60: 12–17PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • B. D. Matthews
    • 1
    • 2
  • R. M. Walsh
    • 1
    • 2
  • K. W. Kercher
    • 1
    • 2
  • R. F. Sing
    • 1
    • 2
  • B. L. Pratt
    • 1
    • 2
  • G. A. Answini
    • 1
    • 2
  • B. T. Heniford
    • 1
    • 2
  1. 1.Department of SurgeryCarolinas Medical CenterCharlotteUSA
  2. 2.The Cleveland Clinic FoundationClevelandUSA

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