Advertisement

Surgical Endoscopy

, Volume 22, Issue 2, pp 487–494 | Cite as

Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location

  • A. Privette
  • L. McCahill
  • E. Borrazzo
  • Richard M. Single
  • R. Zubarik
Article

Abstract

Background

Surgical resection of gastric gastrointestinal stromal tumor (GIST) should be optimized to achieve a negative pathologic surgical margin while limiting the extent of stomach volume loss. Careful identification of exact gastric tumor location using preoperative computed tomography (CT) scans and gastroscopy should allow for selection of a specific operative approach.

Methods

This retrospective case series involved 12 patients (7 men and 5 women; mean age, 60.5 years) with suspected gastric GIST undergoing tumor resection at Fletcher Allen Health Care, a university medical center, from January 2005 to August 2006. The main outcome measures were pathologic resection margins, operative time, estimated blood loss (EBL), morbidity, and duration of hospital stay.

Results

The 12 patients were separated into three groups on the basis of tumor location as follows: type 1 (fundus/greater curvature, n = 5), type 2 (prepyloric/antrum, n = 3), and type 3 (lesser curvature/perigastroesophageal junction, n = 4). Preoperative imaging (CT scan and/or endoscopy) used to identify tumor location accurately predicted the operative approach before surgery for 11 of the12 patients. The surgical approach was selected solely by tumor location as follows: type 1 (laparoscopic partial gastrectomy [LPG]), type 2 (laparoscopic distal gastrectomy [LDG]), and type 3 (laparoscopic transgastric resection [LTG]). Nine patients had a final pathologic diagnosis of GIST. The average tumor size was 4.6 cm, but this did not influence procedure selection. Histologic margins were microscopically negative in all patients. The LPG and LTG approaches had similar outcomes in terms of estimated blood loss (EBL; 80 vs 100 ml) and hospital stay (3.4 vs 3.3 days; p = 0.0198), but LTG had longer operative times (236 vs 180 min). The LDG procedure had longer operative times, greater EBL, and a longer hospital stay. The operative morbidity was 17%, and there was no operative mortality.

Conclusion

The selection of an operative technique for resection of gastric submucosal tumors can be based on preoperative identification of tumor location, for better definition of both the extent of gastric resection and the technical complexity of the laparoscopic procedure.

Keywords

Cancer Gastrointestinal stromal tumors GI/endoscopy GIST 

References

  1. 1.
    Bedard EL, Mamazza J, Schlachta CM, Poulin EC (2006) Laparoscopic resection of gastrointestinal stromal tumors: not all tumors are created equal. Surg Endosc 20:500–503CrossRefPubMedGoogle Scholar
  2. 2.
    Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos A, Emile J, Gronchi A, Hogendoorn P, Joensuu H, Cesne A, MacClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, van Glabbeke M, van Oosterom A, Demetri G (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 16:566–578CrossRefPubMedGoogle Scholar
  3. 3.
    Bozettit F, Bonfanti G, Bufalino R, Menotti V, Persano S, Andreola S, Doci R, Gennari L (1982) Adequacy of margins of resection in gastrectomy for cancer. Ann Surg 196:685–690CrossRefGoogle Scholar
  4. 4.
    Corless CL, Fletcher JA, Heinrich MC (2004) Biology of gastrointestinal stromal tumors. J Clin Oncol 22:3813–3825CrossRefPubMedGoogle Scholar
  5. 5.
    CYTEL Software Corp (2001) StatXact 5. CYTEL Software Corp., Cambridge, MAGoogle Scholar
  6. 6.
    DeMatteo RP, Lewis J, Leung D, Mudan S, Woodruff J, Brennan M (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58CrossRefPubMedGoogle Scholar
  7. 7.
    DeMatteo RP, Heinrich M, El-Rifai W, Demetri G (2002) Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol 33:466–477CrossRefPubMedGoogle Scholar
  8. 8.
    Demetri GD (2001) Targeting c-kit mutations in solid tumors: scientific rationale and novel therapeutic options. Semin Oncol 28(5 Suppl 17):19–26CrossRefPubMedGoogle Scholar
  9. 9.
    Joensuu H, Roberts PJ, Sarlomo-Rikala M, Andersson LC, Tervahartiala P, Tuveson D, Silberman S, Capdeville R, Dimitrijevic S, Druker B, Demetri GD (2001) Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 344:1052–1056CrossRefPubMedGoogle Scholar
  10. 10.
    Ludwig K, Wilhelm L, Scharlau U, Amtsberg G, Bernhardt J (2002) Laparoscopic–endoscopic rendezvous resection of gastric tumors. Surg Endosc 16:1561–1565CrossRefPubMedGoogle Scholar
  11. 11.
    Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, Heniford BT (2002) Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 16:803–807CrossRefPubMedGoogle Scholar
  12. 12.
    Nguyen SQ, Divino CM, Wang JL, Dikman SH (2006) Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc 20:713–716CrossRefPubMedGoogle Scholar
  13. 13.
    Novitsky YW, Kercher K, Sing R, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745, discussion 745–747CrossRefPubMedGoogle Scholar
  14. 14.
    Ohgami M, Otani Y, Kumai K, Kubota T, Kim Y, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23:187–192, discussion 192–193CrossRefPubMedGoogle Scholar
  15. 15.
    Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H (2002) Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 16:177–179CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • A. Privette
    • 1
  • L. McCahill
    • 2
  • E. Borrazzo
    • 3
  • Richard M. Single
    • 4
  • R. Zubarik
    • 5
  1. 1.Department of SurgeryFletcher Allen Health Care/University of VermontBurlingtonUSA
  2. 2.Department of Surgical OncologyFletcher Allen Health Care/University of VermontBurlingtonUSA
  3. 3.Department of General SurgeryFletcher Allen Health Care/University of VermontBurlingtonUSA
  4. 4.Department of Mathematics and StatisticsUniversity of VermontBurlingtonUSA
  5. 5.Department of GastroenterologyFletcher Allen Health Care/University of VermontBurlingtonUSA

Personalised recommendations