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Endoscopic-assisted laparoscopic resection for gastric subepithelial tumors

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Abstract

Background

Laparoscopic resection is considered the treatment of choice for gastric subepithelial tumors. Occasionally, it is necessary to perform an intraoperative gastroscopy to localize the lesion. There are no data in the literature addressing the factors that can predict when a combined laparoscopic-endoscopic approach will be needed.

Methods

A retrospective cohort study using a prospectively collected database was conducted. From January 2005 to December 2013, all the patients undergoing a laparoscopic gastric resection for subepithelial tumors irresectable by endoscopy were reviewed. Potential predictive factors for the need of an intraoperative endoscopy were analyzed.

Results

Thirty-eight consecutive patients (22 men and 16 women) with a mean age of 67 (41–86) years underwent laparoscopic gastric resection for subepithelial tumors. Fourteen (36.8 %) patients required intraoperative endoscopic assessment. The only significant factors related to the need of endoscopic assessment during surgery were tumor growth pattern (P = 0.002) and size (P = 0.001).

Conclusions

An accurate description of tumor growth pattern and size by EUS is recommended in the preoperative assessment of gastric subepithelial tumors. Small tumors (≤18 mm) with an intraluminal growth may need a combined endoscopic-assisted laparoscopic management.

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References

  1. Hedenbro JL, Ekelund M, Wetterberg P (1991) Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc 5:20–23

    Article  PubMed  CAS  Google Scholar 

  2. Hwang JH, Rulyak SD, Kimmey MB (2006) American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 130:2217–2228. doi:10.1053/j.gastro.2006.04.033

    Article  PubMed  Google Scholar 

  3. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two Hundred Gastrointestinal Stromal Tumors. Ann Surg 231:51. doi:10.1097/00000658-200001000-00008

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Clinical E, Guidelines P (2012) Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii92–vii99. doi:10.1093/annonc/mds253

    Google Scholar 

  5. Clinical E, Guidelines P (2012) Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii49–vii55. doi:10.1093/annonc/mds252

    Google Scholar 

  6. 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. doi:10.1007/s00464-006-9065-z

    Article  PubMed  Google Scholar 

  7. Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745; discussion 745–747. doi:10.1097/01.sla.0000219739.11758.27

  8. Melstrom LG, Phillips JD, Bentrem DJ, Wayne JD (2012) Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Am J Clin Oncol 35:451–454. doi:10.1097/COC.0b013e31821954a7

    Article  PubMed  Google Scholar 

  9. Koh Y-X, Chok A-Y, Zheng H-L, Tan C-S, Chow PKH, Wong W-K, Goh BKP (2013) A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol 20:3549–3560. doi:10.1245/s10434-013-3051-1

    Article  PubMed  Google Scholar 

  10. Wilhelm D, von Delius S, Burian M, Schneider A, Frimberger E, Meining A, Feussner H (2008) Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses–analysis of 93 interventions. World J Surg 32:1021–1028. doi:10.1007/s00268-008-9492-1

    Article  PubMed  CAS  Google Scholar 

  11. Hepworth CC, Menzies D, Motson RW (2000) Minimally invasive surgery for posterior gastric stromal tumors 349–353. doi:10.1007/s004640020062

  12. Mochizuki Y, Kodera Y, Fujiwara M, Ito S, Yamamura Y, Sawaki A, Yamao K, Kato T (2006) Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today 36:341–347. doi:10.1007/s00595-005-3164-7

    Article  PubMed  Google Scholar 

  13. Hindmarsh A, Koo B, Lewis MPN, Rhodes M (2005) Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc 19:1109–1112. doi:10.1007/s00464-004-8168-7

    Article  PubMed  CAS  Google Scholar 

  14. Choi YB, Oh ST (2000) Surg Endosc 741–745. doi:10.1007/s004640000148

  15. Huguet KL, Rush RM, Tessier DJ, Schlinkert RT, Hinder RA, Grinberg GG, Kendrick ML, Harold KL (2008) Laparoscopic gastric gastrointestinal stromal tumor resection: the mayo clinic experience. Arch Surg 143:587–590; discussion 591. doi:10.1001/archsurg.143.6.587

  16. Lin Y-M, Hsieh C-H, Cheng C-I, Tan B-L, Liu H-T (2012) Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg 35:113–116. doi:10.1016/j.asjsur.2012.04.014

    Article  PubMed  Google Scholar 

  17. Privette A, McCahill L, Borrazzo E, Single RM, Zubarik R (2008) Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location. Surg Endosc 22:487–494. doi:10.1007/s00464-007-9493-4

    Article  PubMed  CAS  Google Scholar 

  18. Heinrich MC, Corless CL (2005) Gastric GI stromal tumors (GISTs): the role of surgery in the era of targeted therapy. J Surg Oncol 90:195–207; discussion 207. doi:10.1002/jso.20230

  19. Rosen MJ, Heniford BT (2005) Endoluminal gastric surgery: the modern era of minimally invasive surgery. Surg Clin North Am 85:989–1007, vii. doi:10.1016/j.suc.2005.05.010

  20. Yoshida M, Otani Y, Ohgami M, Kubota T, Kumai K, Mukai M, Kitajima M (1997) Surgical management of gastric leiomyosarcoma: evaluation of the propriety of laparoscopic wedge resection. World J Surg 21:440–443

    Article  PubMed  CAS  Google Scholar 

  21. Demetri GD, Benjamin RS, Blanke CD, Blay J-Y, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS, Fisher GA, Fletcher CDM, Gronchi A, Hohenberger P, Hughes M, Joensuu H, Judson I, Le Cesne A, Maki RG, Morse M, Pappo AS, Pisters PWT, Raut CP, Reichardt P, Tyler DS, Van den Abbeele AD, von Mehren M, Wayne JD, Zalcberg J (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)–update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5(Suppl 2):S1–S29; quiz S30

  22. Geis WP, Baxt R, Kim HC (1996) Benign gastric tumors. Minimally invasive approach. Surg Endosc 10:407–410

    Article  PubMed  CAS  Google Scholar 

  23. Allam ME, Mehta D, Zelen J, Fogler R (1998) Posterior wall gastric leiomyoma: endoscopic tattooing facilitates laparoscopic resection. JSLS 2:83–84

    PubMed  CAS  PubMed Central  Google Scholar 

  24. Schubert D, Kuhn R, Nestler G, Kahl S, Ebert MP, Malfertheiner P, Lippert H, Pross M (2005) Laparoscopic-endoscopic rendezvous resection of upper gastrointestinal tumors. Dig Dis 23:106–112. doi:10.1159/000088591

    Article  PubMed  CAS  Google Scholar 

  25. Shimizu S, Noshiro H, Nagai E, Uchiyama A, Mizumoto K, Tanaka M (2002) Laparoscopic wedge resection of gastric submucosal tumors. Dig Surg 19:169–173

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Drs. Jaime Sampson Dávila, Dulce Momblán, Àngels Ginès, Cristina Sánchez Montes, Isis Araujo, David Saavedra-Pérez, and Gloria Fernández-Esparrach have no conflicts of interest or financial ties to disclose. Dr. Antonio M. Lacy is consultant for Covidien and Olympus Medical.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Jaime Sampson Dávila, Dulce Momblán, David Saavedra-Pérez & Antonio M. Lacy

  2. Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Àngels Ginès, Cristina Sánchez-Montes, Isis Araujo & Gloria Fernández-Esparrach

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  1. Jaime Sampson Dávila
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  2. Dulce Momblán
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  3. Àngels Ginès
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  4. Cristina Sánchez-Montes
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Correspondence to Antonio M. Lacy or Gloria Fernández-Esparrach.

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Dávila, J.S., Momblán, D., Ginès, À. et al. Endoscopic-assisted laparoscopic resection for gastric subepithelial tumors. Surg Endosc 30, 199–203 (2016). https://doi.org/10.1007/s00464-015-4183-0

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  • DOI: https://doi.org/10.1007/s00464-015-4183-0

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