Advertisement

Journal of Gastrointestinal Surgery

, Volume 12, Issue 3, pp 561–568 | Cite as

Laparoscopic Treatment of Gastric Gist: Report of 21 Cases and Literature’s Review

  • Fausto CatenaEmail author
  • Monica Di Battista
  • Pietro Fusaroli
  • Luca Ansaloni
  • Valerio Di Scioscio
  • Donatella Santini
  • Maria Pantaleo
  • Guido Biasco
  • Giancarlo Caletti
  • Antonio Pinna
original article

Abstract

Background

Although the feasibility of laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) has been established, various aspects are debated. This paper describes the problems of minimally invasive resection of gastric GISTs and compares this experience with an extensive literature review.

Study Design

Between August 2001 and December 2006, 21 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a prospective study. A literature review of laparoscopic treatment was performed on Pubmed using keywords GIST and surgery. A comparison with authors’ experience with open wedge-segmental resection of GISTs (25 cases from November 1995 to December 2000) was also carried out. Statistical analysis was based on chi-squared test and t Student evaluation.

Results

Twenty-one patients, mean age 50.1 years (range, 34–68 years), were submitted to laparoscopic wedge- segmental gastric resections. Mean tumor size was 4.5 cm (range, 2.0–8.5 cm). Mean operative time was 151 min (range, 52–310 min), the mean blood loss was 101 mL (range, 10–250 mL), and the mean hospital stay was 4.8 days (range 3–7 days). There were no major operative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 35 months, all patients were disease-free. Morbidity, mortality, length of stay, and oncologic outcomes were comparable to the open surgery retrospective evaluation (p = not significant).

Conclusions

As found also in the literature review, the laparoscopic resection is safe and effective in treating gastric GISTs. Given these findings as well as the advantages afforded by laparoscopic surgery, a minimally invasive approach should be the preferred surgical treatment in patients with small- and medium-sized gastric GISTs.

Keywords

GIST Laparoscopy Surgery 

Abbreviations

GIST

gastrointestinal stromal tumors

References

  1. 1.
    Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol 2004;22:3813–3825.PubMedCrossRefGoogle Scholar
  2. 2.
    DeMatteo RP, Lewis JJ, Leung D. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51–58.PubMedCrossRefGoogle Scholar
  3. 3.
    Nowain A, Bhakta H, Pais S. Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol 2005;20:818–824.PubMedCrossRefGoogle Scholar
  4. 4.
    Graadt van Roggen JF, van Velthuysen ML, Hogendoorn PC. The histopathological differential diagnosis of gastrointestinal stromal tumours. J Clin Pathol 2001;54:96–102.PubMedCrossRefGoogle Scholar
  5. 5.
    Catena F, Pasqualini E, Campione O. Gastrointestinal stromal tumors: experience of an emergency surgery department. Dig Surg 2000;17(5):503–507.PubMedCrossRefGoogle Scholar
  6. 6.
    Miettinen M, Virolainen M, Maarit Sarlomo R. Gastrointestinal stromal tumors: value of CD34 antigen in their identification and separation from true leiomyomas and schwannomas. Am J Surg Pathol 1995;19:207–216.PubMedGoogle Scholar
  7. 7.
    Sarlomo-Rikala M, Kovatich AJ, Barusevicius A. CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34. Mod Pathol 1998;11:728–734.PubMedGoogle Scholar
  8. 8.
    Kindblom LG, Remotti HE, Aldenborg F. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259–1269.PubMedGoogle Scholar
  9. 9.
    Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol 2005;29:52–68.PubMedCrossRefGoogle Scholar
  10. 10.
    Heinrich MC, Corless CL. Gastric GI stromal tumors (GISTs): the role of surgery in the era of targeted therapy. J Surg Oncol 2005;90:195–207.PubMedCrossRefGoogle Scholar
  11. 11.
    Cheng HL, Lee WJ, Lai IR. Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology 1999;46:2100–2104.PubMedGoogle Scholar
  12. 12.
    Matthews BD, Walsh RM, Kercher KW. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 2002;16:803–807.PubMedCrossRefGoogle Scholar
  13. 13.
    National Library of MedicineNational Institutes of Health. National Center for Biotehcnology Information. Bethesda, MD: US National Library of Medicine; 2007. Available at: http://www.ncbi.nlm.nih.gov.Google Scholar
  14. 14.
    Mazur MT, Clark HB. Gastric stromal tumors: reappraisal of histogenesis. Am J Surg Pathol 1983;7:507–519.PubMedCrossRefGoogle Scholar
  15. 15.
    Fujimoto Y, Nakanishi Y, Yoshimura K. Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer 2003;6:39–48.PubMedCrossRefGoogle Scholar
  16. 16.
    Chak A, Canto MI, Rosch T. Endosonographic differentiation of benign and malignant stromal cell tumors. Gastrointest Endosc 1997;45:468–473.PubMedCrossRefGoogle Scholar
  17. 17.
    Walsh RM, Ponsky J, Brody F. Combined endoscopic/laparoscopic intragastric resection of gastric stromal tumors. J Gastrointest Surg 2003;7:386–392.PubMedCrossRefGoogle Scholar
  18. 18.
    Demetri GD, Blanke CD. NCCN Task Force Report. Optimal management of patients with gastrointestinal stromal tumors (GIST): expansion and update of NCCN Clinical Guidelines. J Natl Comp Cancer Network 2004;2(suppl):1–26.Google Scholar
  19. 19.
    The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059.CrossRefGoogle Scholar
  20. 20.
    Basso N, Rosato P, De Leo A, Picconi T, Trentino P, Fantini A, Silecchia G. Laparoscopic treatment of gastric stromal tumors. Surg Endosc 2000;14(6):524–526. (Jun).PubMedCrossRefGoogle Scholar
  21. 21.
    Bedard E, Mamazza J, Schlachta C, Poulin C. Laparoscopic resection of gastrointestinal stromal tumors Not all tumors are created equal. Surg Endosc 2006;20:500–503.PubMedCrossRefGoogle Scholar
  22. 22.
    Berindoague R, Targarona E, Feliu X. Laparoscopic resection of clinically suspected gastric stromal tumors. Surg Innov 2006;13:231.PubMedCrossRefGoogle Scholar
  23. 23.
    Choi SM, Kim MC, Jung GJ, Kim HH, Kwon HC, Choi SR, Jang JS, Jeong JS. Laparoscopic wedge resection for gastric GIST: Long-term follow-up results. Eur J Surg Oncol 2007;33(4):444–447. (May).PubMedCrossRefGoogle Scholar
  24. 24.
    Dulucq J, Wintringer P, Mahajna A. Totally laparoscopic trans-hiatal gastroesophagectomy for benign diseases of the esophago-gastric junction. World J Gastroenterol 2007;13(2):285–288. (January 14).PubMedGoogle Scholar
  25. 25.
    Feliu X, Besora P, Claveria R. Laparoscopic treatment of gastric tumors. J Laparoendosc Adv Surg Tech A 2007;17(2):147–152. (Apr).PubMedGoogle Scholar
  26. 26.
    Granger S, Rollins MD, Mulvihill SJ, Glasgow RE. Lessons learned from laparoscopic treatment of gastric and gastroesophageal junction stromal cell tumors. Surg Endosc 2006;20:1299–1304.PubMedCrossRefGoogle Scholar
  27. 27.
    Hepworth CC, Menzies D, Motson RW. Minimally invasive surgery for posterior gastric stromal tumors. Surg Endosc 2000;14(4):349–353. (Apr).PubMedCrossRefGoogle Scholar
  28. 28.
    Hindmarsh A, Koo B, Lewis MP, Rhodes M. Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc 2005;19:1109–1112.PubMedCrossRefGoogle Scholar
  29. 29.
    Iwahashi M, Takifuji K, Ojima T, Nakamura M, Nakamori M, Nakatani Y, Ueda K, Ishida K, Naka T, Ono K, Yamaue H. Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 2006;30:28–35.PubMedCrossRefGoogle Scholar
  30. 30.
    Lai IR, Lee WJ, Yu SC. Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results. J Gastrointest Surg 2006;10(4):563–565. (Apr).PubMedCrossRefGoogle Scholar
  31. 31.
    Ludwig K, Weiner R, Bernhardt J. Ludwig minimally invasive resections of gastric tumors. Chirurg 2003;74:632–637.PubMedCrossRefGoogle Scholar
  32. 32.
    Mochizuki Y, Kodera Y, Fujiwara M, Ito S, Yamamura Y, Sawaki A, Yamao K, Kato T. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today 2006;36(4):341–347.PubMedCrossRefGoogle Scholar
  33. 33.
    Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 2006;243:738–747.PubMedCrossRefGoogle Scholar
  34. 34.
    Nguyen SQ, Divino CM, Wang JL, Dikman SH. Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc 2006;20(5):713–716. (May).PubMedCrossRefGoogle Scholar
  35. 35.
    Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M. Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 2006;139(4):484–492. (Apr).PubMedCrossRefGoogle Scholar
  36. 36.
    Rivera RE, Eagon JC, Soper NJ, Klingensmith ME, Brunt LM. Rivera experience with laparoscopic gastric resection results and outcomes for 37 cases. Surg Endosc 2005;19:1622–1626.PubMedCrossRefGoogle Scholar
  37. 37.
    Rothlin M, Schob O. Laparoscopic wedge resection for benign gastric tumors. Surg Endosc 2001;15(8):893–895. (Aug).PubMedCrossRefGoogle Scholar
  38. 38.
    Santambrogio R, Montorsi M, Schubert L, Pisani Ceretti A, Costa M, Moroni E, Opocher E. Laparoscopic ultrasound-guided resection of gastric submucosal tumors. Surg Endosc 2006;20:1305–1307.PubMedCrossRefGoogle Scholar
  39. 39.
    Sanchez BR, Morton JM, Curet MJ, Alami RS, Safadi BY. Incidental finding of gastrointestinal stromal tumors (GISTs) during laparoscopic gastric bypass. Obes Surg 2005;15(10):1384–1388. (Nov–Dec).PubMedCrossRefGoogle Scholar
  40. 40.
    Schafer H, Schneider PM, Baldus SE, Wolfgarten E, Holscher AH. Combined laparoscopic/endoscopic treatment of gastric stroma tumors]. Zentralbl Chir 2006;131(3):206–209. (In German; Jun).PubMedGoogle Scholar
  41. 41.
    Yano H, Kimura Y, Iwazawa T, Takemoto H, Imasato M, Monden T, Okamoto S. Hand-assisted laparoscopic surgery for a large gastrointestinal stromal tumor of the stomach. Gastric Cancer 2005;8(3):186–192.PubMedCrossRefGoogle Scholar
  42. 42.
    Schnadig ID, Blanke CD. Gastrointestinal stromal tumors: imatinib and beyond. Curr Treat Opt Oncol 2006;7(6):427–437.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Fausto Catena
    • 1
    • 2
    Email author
  • Monica Di Battista
    • 1
    • 2
  • Pietro Fusaroli
    • 1
    • 2
  • Luca Ansaloni
    • 1
    • 2
  • Valerio Di Scioscio
    • 1
    • 2
  • Donatella Santini
    • 1
    • 2
  • Maria Pantaleo
    • 1
    • 2
  • Guido Biasco
    • 1
    • 2
  • Giancarlo Caletti
    • 1
    • 2
  • Antonio Pinna
    • 1
    • 2
  1. 1.Transplant, General and Emergency Surgery DepartmentSt Orsola-Malpighi University HospitalBolognaItaly
  2. 2.GIST Working GroupUniversity of BolognaBolognaItaly

Personalised recommendations