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Surgery Today

, Volume 42, Issue 6, pp 554–558 | Cite as

Laparoscopic resection for gastrointestinal stromal tumors in the stomach

  • Yoshihiro KakejiEmail author
  • Tomonori Nakanoko
  • Rintaro Yoshida
  • Kojiro Eto
  • Ryuichi Kumashiro
  • Keisuke Ikeda
  • Akinori Egashira
  • Hiroshi Saeki
  • Eiji Oki
  • Masaru Morita
  • Tetsuo Ikeda
  • Yoshihiko Maehara
Original Article

Abstract

Purpose

Gastrointestinal stromal tumors (GISTs) should be surgically resected, even those smaller than 5 cm in size, which is the threshold of clinical malignancy for submucosal tumors (SMTs) in the gastrointestinal tract. This study reviewed the use of laparoscopic surgery for gastric partial resection of GISTs or SMTs that were suspected to be GISTs.

Methods

Eighteen patients underwent laparoscopic partial resection of the stomach for GISTs or SMTs. The tumor location was confirmed by intraluminal endoscopy. One-half of the circumference around the tumor was dissected, and the tumor was turned toward the abdominal cavity. The nonresected part of the tumor and the edge of the incision line was lifted up using forceps, and the incision line was closed using laparoscopic stapling devices.

Results

Two cases were diagnosed as GIST by endoscopic biopsy. Six patients underwent endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) examinations, which diagnosed five GISTs. There were 18 tumors smaller than 5 cm, including 10 GISTs, 4 leiomyomas, 3 schwannomas, and one heterotopic pancreas.

Conclusions

Endoscopic ultrasound-guided FNAB is recommended for definite preoperative diagnosis of histopathologically unknown SMTs to determine the indications for surgery. The laparoscopic approach with the assistance of endoscopy is useful for improving the curability, with minimal invasiveness for the partial resection of GISTs.

Keywords

Gastrointestinal stromal tumor Submucosal tumor Laparoscopic resection Endoscopic ultrasound-guided fine-needle aspiration biopsy 

Notes

Conflict of interest

Yoshihiro Kakeji and co-authors have no conflict of interest.

References

  1. 1.
    Nishida T, Hirota S. Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol. 2000;15:1293–301.PubMedGoogle Scholar
  2. 2.
    Rubin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumour. Lancet. 2007;369:1731–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)–update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007;5 suppl 2:S1–29 (quiz S30).Google Scholar
  5. 5.
    Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. 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. 2005;16:566–78.PubMedCrossRefGoogle Scholar
  6. 6.
    DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231:51–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006;243:738–45. discussion 745–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc. 2008;22:2583–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, et al. Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery. 2006;139:484–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, et al. Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery. 2010;147:516–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Karakousis GC, Singer S, Zheng J, Gonen M, Coit D, Dematteo RP, et al. Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol. 2011;18:1599–605.PubMedCrossRefGoogle Scholar
  12. 12.
    Nishida T, Hirota S, Yanagisawa A, Sugino Y, Minami M, Yamamura Y, et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol. 2008;13:416–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol. 1999;30:1213–20.PubMedCrossRefGoogle Scholar
  15. 15.
    Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459–65.PubMedCrossRefGoogle Scholar
  16. 16.
    Ponsaing LG, Kiss K, Hansen MB. Classification of submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 2007;13:3311–5.PubMedGoogle Scholar
  17. 17.
    Chang KJ, Katz KD, Durbin TE, Erickson RA, Butler JA, Lin F, et al. Endoscopic ultrasound-guided fine-needle aspiration. Gastrointest Endosc. 1994;40:694–9.PubMedGoogle Scholar
  18. 18.
    Ando N, Goto H, Niwa Y, Hirooka Y, Ohmiya N, Nagasaka T, et al. The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc. 2002;55:37–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB. Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 2007;13:3301–10.PubMedGoogle Scholar
  20. 20.
    Ludwig K, Wilhelm L, Scharlau U, Amtsberg G, Bernhardt J. Laparoscopic-endoscopic rendezvous resection of gastric tumors. Surg Endosc. 2002;16:1561–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc. 2008;22:1729–35.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Yoshihiro Kakeji
    • 1
    Email author
  • Tomonori Nakanoko
    • 1
  • Rintaro Yoshida
    • 1
  • Kojiro Eto
    • 1
  • Ryuichi Kumashiro
    • 1
  • Keisuke Ikeda
    • 1
  • Akinori Egashira
    • 1
  • Hiroshi Saeki
    • 1
  • Eiji Oki
    • 1
  • Masaru Morita
    • 1
  • Tetsuo Ikeda
    • 1
  • Yoshihiko Maehara
    • 1
  1. 1.Department of Surgery and ScienceGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan

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