Abstract
Background
Laparoscopic resection of gastric stromal tumors is being performed with increased frequency. This study aims to evaluate the feasibility and safety of the extraluminal laparoscopic gastric wedge resection (ELWR) technique.
Methods
Clinical data of 84 patients who underwent ELWR for gastric submucosal tumors between September 2000 and December 2007 were reviewed and analyzed retrospectively. The operation includes: localization of the tumor, dissection of the omentum, mobilization of the upper stomach and the upper pole of the spleen, exposure of esophago-cardiac junction (ECJ), and wedge resection of the upper part of gastric body and/or the gastric fundus with endoscopic gastrointestinal anastomosis (Endo GIA) stapler.
Results
All of the procedures were performed successfully, with mean operation time of 62.6 ± 8.9 min and mean intraoperative blood loss of 86.2 ± 8.1 ml. Through extraluminal laparoscopic wedge resection, complete R0 resection was achieved for all tumors. All surgical margins were negative microscopically. No lesions were missed, nor were there any significant postoperative complications or intraoperative conversions to open surgery. A total of 78.6% of the patients recovered their gastrointestinal functions and began to eat and ambulate within 36 h of the operation. The smallest surgical margins were 0.7–2.5 cm, with a mean distance of 1.4 ± 0.5 cm. Of the 84 cases of gastric submucosal tumors, 29 cases were leiomyomas, 51 cases were various types of stromal tumors, and 4 other cases were neurofibromas. Mean follow-up duration was 51 ± 4.3 months (overall follow-up rate 73.8%, 62/84 cases), during which no recurrences or metastases were found.
Conclusion
ELWR is a safe, simple, and effective procedure for treating submucosal tumors in the upper part of the stomach. It can avoid intraperitoneal contamination, possible tumor spillage, and postoperative esophageal stenosis, and provides unlimited scope for gastric resection.
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References
Gold JS, Dematteo RP (2006) Combined surgical and molecular therapy: the gastrointestinal stromal tumor model. Ann Surg 244:176–184
Ke ZW, Zheng CZ, Hu MG, Chen DL (2004) Laparoscopic resection of submucosal tumor on posterior wall of gastric fundus. World J Gastroenterol 10:2850–2853
Mazur MT, Clark HB (1983) Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol 7:507–519
Bertolini V, Chiaravalli AM, Klersy C, Placidi C, Marchet S, Boni L, Capella C (2008) Gastrointestinal stromal tumors–frequency, malignancy, and new prognostic factors: the experience of a single institution. Pathol Res Pract 204:219–233
Group LR (2009) Managing initial recurrence. Available at: http://www.liferaftgroup.org/gist_recurrence.html. October 2009
Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, Muhammad Tunio G, Matsuzawa Y, Kanakura Y, Shinomura Y, Kitamura Y (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279:577–580
Miettinen M, Lasota J (2001) Gastrointestinal stromal tumors–definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 438:1–12
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 16:803–807
Cuschieri A (2000) Laparoscopic gastric resection. Surg Clin North Am 80:1269–1284, viii
DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58
Roberts PJ, Eisenberg B (2002) Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 38(Suppl 5):S37–S38
Nishimura J, Nakajima K, Omori T, Takahashi T, Nishitani A, Ito T, Nishida T (2007) Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc 21:875–878
Dulucq JL, Wintringer P, Mahajna A (2007) Totally laparoscopic trans-hiatal gastroesophagectomy for benign diseases of the esophago-gastric junction. World J Gastroenterol 13:285–288
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 13:71–74
Walsh RM, Ponsky J, Brody F, Matthews BD, Heniford BT (2003) Combined endoscopic/laparoscopic intragastric resection of gastric stromal tumors. J Gastrointest Surg 7:386–392
Berindoague R, Targarona EM, Feliu X, Artigas V, Balague C, Aldeano A, Lahoud A, Navines J, Fernandez-Sallent E, Trias M (2006) Laparoscopic resection of clinically suspected gastric stromal tumors. Surg Innov 13:231–237
Nguyen SQ, Divino CM, Wang JL, Dikman SH (2006) Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc 20:713–716
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 139:484–492
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Authors Chong-wei Ke, Jing-li Cai, Dan-lei Chen, and Cheng-zhu Zheng have no conflicts of interest or financial ties to disclose.
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Ke, Cw., Cai, Jl., Chen, Dl. et al. Extraluminal laparoscopic wedge resection of gastric submucosal tumors: a retrospective review of 84 cases. Surg Endosc 24, 1962–1968 (2010). https://doi.org/10.1007/s00464-010-0888-2
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DOI: https://doi.org/10.1007/s00464-010-0888-2