Advertisement

Surgical Endoscopy

, 23:1980 | Cite as

Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus

  • Sun-Hwi Hwang
  • Do Joong Park
  • Young Hoon Kim
  • Kyoung Ho Lee
  • Hye Seung Lee
  • Hyung-Ho KimEmail author
  • Hyuk-Joon Lee
  • Han-Kwang Yang
  • Kuhn Uk Lee
Article

Abstract

Background

Laparoscopic partial gastric resection is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, SMTs of either end of the stomach are generally managed by subtotal gastrectomies or total gastrectomies. This study was conducted to evaluate surgical techniques for management of SMTs located at the ends of the stomach.

Methods

Among 63 patients who were diagnosed and underwent laparoscopic surgery for gastric SMTs at Seoul National University Bundang Hospital from May 2003 to May 2007, 11 SMTs located at the ends of the stomach were identified. The clinicopathologic results of these 11 SMTs were analyzed.

Results

Laparoscopic partial wedge resections or tumor excisions were successfully performed on all patients except for those who had prepyloric tumors. Six men and five women had SMTs at the ends of the stomach. The patients ranged in age from 21–63 years (mean 43.4 ± 13.5 years). Of six esophagogastric junctional tumors that showed low, homogeneous contrast enhancement on computed tomography (CT) scans, five were treated by laparoscopic transgastric enucleation and one by tumor-everting resection. One esophagogastric junctional tumor that leaned toward the fundus and showed a 6-cm-diameter endophytic mass with heterogeneous enhancement on CT scan was resected by laparoscopic wedge resection. The mean operation time was 100 min (range 60–210 min). Three laparoscopy-assisted distal gastrectomies and one laparoscopic wedge resection were performed on SMTs located near the prepyloric antrum. There were no intra- or postoperative complications. Duration of postoperative hospital stay ranged from 4–7 days.

Conclusion

Laparoscopic local resection is an effective treatment for SMTs located at the esophagogastric junction and can be used instead of a total or proximal gastrectomy. However, gastrectomies should be considered for SMTs located near the pylorus because of the small volume of the lower third of the stomach.

Keywords

Laparoscopy Submucosal tumors Gastric Esophagogastric junction Prepylorus 

References

  1. 1.
    Ishikawa K, Inomata M, Etoh T, Shiromizu A, Shiraishi N, Arita T, Kitano S (2006) Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech 16:82–85PubMedCrossRefGoogle Scholar
  2. 2.
    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 16:803–807PubMedCrossRefGoogle Scholar
  3. 3.
    Peters JH, Ellison EC, Innes JT, Liss JL, Nichols KE, Lomano JM, Roby SR, Front ME, Carey LC (1991) Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg 213:3–12PubMedCrossRefGoogle Scholar
  4. 4.
    Senagore AJ, Luchtefeld MA, Mackeigan JM, Mazier WP (1993) Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 59:549–553; discussion 553–554PubMedGoogle Scholar
  5. 5.
    Goh P, Tekant Y, Isaac J, Kum CK, Ngoi SS (1992) The technique of laparoscopic Billroth II gastrectomy. Surg Laparosc Endosc 2:258–260PubMedGoogle Scholar
  6. 6.
    Kitano S, Shiraishi N (2005) Minimally invasive surgery for gastric tumors. Surg Clin North Am 85:151–164, xiPubMedCrossRefGoogle Scholar
  7. 7.
    Cheng HL, Lee WJ, Lai IR, Yuan RH, Yu SC (1999) Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology 46:2100–2104PubMedGoogle Scholar
  8. 8.
    Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7:705–712PubMedCrossRefGoogle Scholar
  9. 9.
    Aogi K, Hirai T, Mukaida H, Toge T, Haruma K, Kajiyama G (1999) Laparoscopic resection of submucosal gastric tumors. Surg Today 29:102–106PubMedCrossRefGoogle Scholar
  10. 10.
    Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664PubMedCrossRefGoogle Scholar
  11. 11.
    Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M (2006) Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139:484–492PubMedCrossRefGoogle Scholar
  12. 12.
    Iwahashi M, Takifuji K, Ojima T, Nakamura M, Nakamori M, Nakatani Y, Ueda K, Ishida K, Naka T, Ono K, Yamaue H (2006) Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 30:28–35PubMedCrossRefGoogle Scholar
  13. 13.
    Basso N, Rosato P, De Leo A, Picconi T, Trentino P, Fantini A, Silecchia G (2000) Laparoscopic treatment of gastric stromal tumors. Surg Endosc 14:524–526PubMedCrossRefGoogle Scholar
  14. 14.
    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 16:177–179PubMedCrossRefGoogle Scholar
  15. 15.
    Tagaya N, Mikami H, Kubota K (2004) Laparoscopic resection of gastrointestinal mesenchymal tumors located in the upper stomach. Surg Endosc 18:1469–1474PubMedCrossRefGoogle Scholar
  16. 16.
    Cugat E, Hoyuela C, Rodriguez-Santiago JM, Marco C (1999) Laparoscopic ultrasound guidance for laparoscopic resection of benign gastric tumors. J Laparoendosc Adv Surg Tech A 9:63–67PubMedCrossRefGoogle Scholar
  17. 17.
    Hepworth CC, Menzies D, Motson RW (2000) Minimally invasive surgery for posterior gastric stromal tumors. Surg Endosc 14:349–353PubMedCrossRefGoogle Scholar
  18. 18.
    Ibrahim IM, Silvestri F, Zingler B (1997) Laparoscopic resection of posterior gastric leiomyoma. Surg Endosc 11:277–279PubMedCrossRefGoogle Scholar
  19. 19.
    Sekimoto M, Tamura S, Hasuike Y, Yano M, Murata A, Inoue M, Shiozaki H, Monden M (1999) A new technique for laparoscopic resection of a submucosal tumor on the posterior wall of the gastric fundus. Surg Endosc 13:71–74PubMedCrossRefGoogle Scholar
  20. 20.
    Taniguchi E, Kamiike W, Yamanishi H, Ito T, Nezu R, Nishida T, Momiyama T, Ohashi S, Okada T, Matsuda H (1997) Laparoscopic intragastric surgery for gastric leiomyoma. Surg Endosc 11:287–289PubMedCrossRefGoogle Scholar
  21. 21.
    Uchikoshi F, Ito T, Nishida T, Kitagawa T, Endo S, Matsuda H (2004) Laparoscopic intragastric resection of gastric stromal tumor located at the esophago-cardiac junction. Surg Laparosc Endosc Percutan Tech 14:1–4PubMedCrossRefGoogle Scholar
  22. 22.
    Walsh RM, Ponsky J, Brody F, Matthews BD, Heniford BT (2003) Combined endoscopic/laparoscopic intragastric resection of gastric stromal tumors. J Gastrointest Surg 7:386–392PubMedCrossRefGoogle Scholar
  23. 23.
    Watson DI, Game PA, Devitt PG (1996) Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc 10:540–541PubMedCrossRefGoogle Scholar
  24. 24.
    Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S (1995) Laparoscopic and minilaparotomy proximal gastrectomy and esophagogastrostomy: technique and case report. Surg Laparosc Endosc 5:487–491PubMedGoogle Scholar
  25. 25.
    Rohatgi A, Singh KK (2003) Laparoendoscopic management of gastrointestinal stromal tumors. J Laparoendosc Adv Surg Tech A 13:37–40PubMedCrossRefGoogle Scholar
  26. 26.
    Boggino HE, Fernandez MP, Logrono R (2000) Cytomorphology of gastrointestinal stromal tumor: diagnostic role of aspiration cytology, core biopsy, and immunochemistry. Diagn Cytopathol 23:156–160PubMedCrossRefGoogle Scholar
  27. 27.
    Caletti G, Zani L, Bolondi L, Brocchi E, Rollo V, Barbara L (1989) Endoscopic ultrasonography in the diagnosis of gastric submucosal tumor. Gastrointest Endosc 35:413–418PubMedCrossRefGoogle Scholar
  28. 28.
    Lee MJ, Lim JS, Kwon JE, Kim H, Hyung WJ, Park MS, Kim MJ, Kim KW (2007) Gastric true leiomyoma: computed tomographic findings and pathological correlation. J Comput Assist Tomogr 31:204–208PubMedCrossRefGoogle Scholar
  29. 29.
    Yang PS, Lee KS, Lee SJ, Kim TS, Choo IW, Shim YM, Kim K, Kim Y (2001) Esophageal leiomyoma: radiologic findings in 12 patients. Korean J Radiol 2:132–137PubMedCrossRefGoogle Scholar
  30. 30.
    Lee JH, Han HS, Kim YW, Min SK, Lee HK (2003) Laparoscopic wedge resection with handsewn closure for gastroduodenal tumors. J Laparoendosc Adv Surg Tech A 13:349–353PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sun-Hwi Hwang
    • 1
  • Do Joong Park
    • 1
  • Young Hoon Kim
    • 2
  • Kyoung Ho Lee
    • 2
  • Hye Seung Lee
    • 3
  • Hyung-Ho Kim
    • 1
    • 4
    Email author
  • Hyuk-Joon Lee
    • 4
    • 5
  • Han-Kwang Yang
    • 4
    • 5
  • Kuhn Uk Lee
    • 4
  1. 1.Department of SurgerySeoul National University Bundang HospitalGyeonggiKorea
  2. 2.Department of RadiologySeoul National University Bundang HospitalGyeonggiKorea
  3. 3.Department of PathologySeoul National University Bundang HospitalGyeonggiKorea
  4. 4.Department of SurgerySeoul National University College of MedicineSeoulKorea
  5. 5.Cancer Research InstituteSeoul National University College of MedicineSeoulKorea

Personalised recommendations