Full-thickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach
- 326 Downloads
Until now, the conventional treatment of stromal tumors has been primarily open surgery or laparoscopic excision. The use of combined laparoscopic/endoscopic surgeries has been investigated, but endoscopic therapy alone has been limited to en bloc resection or nucleus removal of intracavitary tumors with diameters <2 cm. Nonintracavitary and intramural gastric stromal tumors preclude the use of endoscopic resection due to the risk of gastric perforation. This study was designed to show the safety and effectiveness of full-thickness endoscopic resection of nonintracavitary stromal tumors based on our direct experience.
A total of 109 consecutive patients with nonintracavitary gastric stromal tumors <4 cm in diameter underwent surgical treatment; 66 patients received endoscopic surgery and 43 patients received laparoscopic surgery.
No significant differences existed between the two groups in terms of demographics and clinical characteristics, and no tumor exceeded 3.5 cm in size. Median operation times (endoscopic group, 53.6 min; laparoscopic group, 139 min) and hospitalization fees of the endoscopic group were significantly lower than those of the laparoscopic group with significant median hospital stays (8 days for endoscopic group; 6 days for laparoscopic group). No intraoperative complications occurred in the laparoscopic group and complete removal of tumors was achieved in the endoscopic group. Postoperative complications occurred in 6 patients of 43 who underwent laparoscopic surgery and 17 patients of 66 who underwent endoscopic surgery, representing a significant difference; the size of the lesion correlated positively with the occurrence of complications.
Endoscopic resection is safe and effective for treating nonintracavitary stromal tumors. The endoscopic natural-cavity technique produced less surgical injury to the patients and preserved the anatomy of intra-abdominal structures. In addition, the endoscopic technique reduced operative times, postoperative bleeding, and costs.
KeywordsNonintracavitary gastric stromal tumor Endoscopic resection Laparoscopic resection
Drs. Lei Wang, Wei Ren, Chao-qiang Fan, Yi-hui Li, Xia Zhang, Jin Yu, Guo-ce Zhao, and Xiao-yan Zhao have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MPG 68098 kb)
- 13.Cavaliere D, Vagliasindi A, Mura G, Framarini M, Giorgetti G, Solfrini G, Tauceri F, Padovani F, Milandri C, Dubini A, Ridolfi L, Ricci E, Verdecchia GM (2007) Downstaging of a gastric GIST by neoadjuvant imatinib and endoscopic assisted laparoscopic resection. Eur J Surg Oncol 33:1044–1046 (epub 2007 Apr 30)PubMedGoogle Scholar
- 19.McGee MF, Schomisch SJ, Marks JM, Delaney C, Jin J, Williams C, Chak A, Andrews J, Ponsky J (2007) Systemic inflammation and physiologic burden of transgastric natural orifice translumenal endoscopic surgery (NOTES) peritoneoscopy: a controlled, prospective comparison between NOTES and laparoscopy. Gastrointest Endosc 65:AB127Google Scholar