Journal of Gastrointestinal Surgery

, Volume 17, Issue 9, pp 1570–1575 | Cite as

Laparoscopic Transgastric Resection of Gastric Submucosal Tumors Located Near the Esophagogastric Junction

  • Xiaowu Xu
  • Ke Chen
  • Wei Zhou
  • Renchao Zhang
  • Jie Wang
  • Di Wu
  • Yiping Mou
Original Article



Laparoscopic wedge resection is widely accepted as a choice of treatment for gastric submucosal tumors (SMTs). But it cannot easily be applied to tumors located near the esophagogastric junction (EGJ) due to the high risk of causing deformity or stenosis in the gastric inlet. We evaluated our laparoscopic transgastric surgical technique for gastric SMTs located near the EGJ and clinical outcomes.


Twelve consecutive patients with gastric intraluminal SMTs located 3 cm or less from the EGJ underwent laparoscopic transgastric resection at our institution from June 2010 to November 2012. The clinicopathological results of these 12 cases were analyzed.


Laparoscopic transgastric resection was successfully performed on all the patients. The mean operation time was 125 ± 25 min (range, 85–160 min) and the mean blood loss was 53 ± 32 mL (range, 10–120 mL). There was no death in our series. One patient experienced a postoperative complication of upper gastrointestinal tract bleeding due to the errhysis along the staple line treated with an endoscopic hemostatic clip. The mean postoperative length of hospital stay was 5.1 ± 1.2 days (range, 3–7 days). All patients received complete resection with a negative margin. Histopathologic diagnoses were gastrointestinal stromal tumor in seven cases, leiomyoma in four, and heterotopic pancreas in one. There was no tumor recurrence or evidence of stenosis of the EGJ during a mean follow-up of 15.3 ± 9.6 months (range, 1–30 months).


Laparoscopic transgastric resection is simple, safe, and effective for gastric intraluminal SMTs located near the EGJ.


Laparoscopy Transgastric resection Submucosal tumors Esophagogastric junction 


  1. 1.
    Cheng HL, Lee WJ, Lai IR, Yuan RH, Yu SC. Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology 1999; 46: 2100–2104.PubMedGoogle Scholar
  2. 2.
    Shimizu S, Noshiro H, Nagai E, Uchiyama A, Mizumoto K, Tanaka M. Laparoscopic wedge resection of gastric submucosal tumors. Dig Surg 2002; 19: 169–173.PubMedCrossRefGoogle Scholar
  3. 3.
    Walsh RM, Heniford BT. Laparoendoscopic treatment of gastric stromal tumors. Semin Laparosc Surg 2001; 8: 189–194.PubMedCrossRefGoogle Scholar
  4. 4.
    Berindoague R, Targarona EM, Feliu X, Artigas V, Balagué C, Aldeano A, Lahoud A, Navines J, Fernandez-Sallent E, Trias M. Laparoscopic resection of clinically suspected gastric stromal tumors. Surg Innov 2006; 13: 231–237.PubMedCrossRefGoogle Scholar
  5. 5.
    Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000; 7: 705–712.PubMedCrossRefGoogle Scholar
  6. 6.
    Tagaya N, Mikami H, Kubota K. Laparoscopic resection of gastrointestinal mesenchymal tumors located in the upper stomach. Surg Endosc 2004; 18: 1469–1474.PubMedCrossRefGoogle Scholar
  7. 7.
    Wiech T, Walch A, Werner M. Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy 2005; 37: 630–634.PubMedCrossRefGoogle Scholar
  8. 8.
    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: 341–347.PubMedCrossRefGoogle Scholar
  9. 9.
    Hasegawa T, Matsuno Y, Shimoda T, Hirohashi S. Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol 2002; 33: 669–676.PubMedCrossRefGoogle Scholar
  10. 10.
    Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol 2002; 3: 655–664.PubMedCrossRefGoogle Scholar
  11. 11.
    Lukaszczyk JJ, Preletz RJ. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg 1992; 2: 331–334.PubMedCrossRefGoogle Scholar
  12. 12.
    De Vogelaere K, Van Loo I, Peters O, Hoorens A, Haentjens P, Delvaux G. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc 2012; 26: 2339–2345.PubMedCrossRefGoogle Scholar
  13. 13.
    Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S. Laparoscopic and minilaparotomy proximal gastrectomy and esophagogastrostomy: technique and case report. Surg Laparosc Endosc 1995; 5: 487–491.PubMedGoogle Scholar
  14. 14.
    Choi YB, Oh ST. Laparoscopy in the management of gastric submucosal tumors. Surg Endosc 2000; 14: 741–745.PubMedCrossRefGoogle Scholar
  15. 15.
    Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H. Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 2002; 16: 177–179.PubMedCrossRefGoogle Scholar
  16. 16.
    Basso N, Silecchia G, Pizzuto G, Surgo D, Picconi T, Materia A. Laparoscopic excision of posterior gastric wall leiomyoma. Surg Laparosc Endosc 1996; 6: 65–67.PubMedCrossRefGoogle Scholar
  17. 17.
    Watson DI, Game PA, Devitt PG. Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc 1996; 10: 540–541.PubMedCrossRefGoogle Scholar
  18. 18.
    Taniguchi E, Kamiike W, Yamanishi H, Ito T, Nezu R, Nishida T, Momiyama T, Ohashi S, Okada T, Matsuda H. Laparoscopic intragastric surgery for gastric leiomyoma. Surg Endosc 1997; 11: 287–289.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee JH, Han HS, Kim YW, Min SK, Lee HK. Laparoscopic wedge resection with handsewn closure for gastroduodenal tumors. J Laparoendosc Adv Surg Tech A 2003; 13: 349–353.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Xiaowu Xu
    • 1
  • Ke Chen
    • 1
  • Wei Zhou
    • 1
  • Renchao Zhang
    • 1
  • Jie Wang
    • 1
  • Di Wu
    • 1
  • Yiping Mou
    • 1
  1. 1.Department of General SurgerySir Run Run Shaw Hospital, Zhejiang University, School of MedicineHangzhouChina

Personalised recommendations