Abstract
Background: Gastric tumors, including early gastric cancers, can be safely removed laparoscopically. They do not require an open laparotomy.
Methods: From March 1995 to December 1998, we used laparoscopy to resect gastric submucosal lesions in 32 patients. There were 22 men and 10 women. The patients ranged in age from 23 to 67 years (median, 51.4 yr). The lesions were located in the upper third in one patient, in the middle third in 20 patients, and in the lower third in 11 patients. The tumors ranged in size from 2 to 6 cm in diameter. The operative procedures were wedge resection in 19 patients, wedge resection with gastrotomy in two patients, intragastric surgery in nine patients, intragastric surgery with gastrotomy in one patient, and proximal gastrectomy in one patient, using a four- or five-port technique. The exophytic mass was resected with an Endo-GIA, and the tumors on the mucosal surface were exposed via a gastrotomy and excised. The gastrotomy was closed with an intracorporeal suture. In all cases, the operation was finished after the confirmation of tumor-free margins on frozen-section biopsy specimens.
Results: The duration of the operation ranged from 80 to 180 mins. The final pathologic findings were leiomyoma in 24 patients, adenomyoma in three patients, hyperplastic polyp in two patients, lipoma in one patient, hamartoma in one patient, and leiomyosarcoma in one patient. One case (3.1%) was converted to a mini-laparotomy due to technical difficulty; in one other case, more margin was resected laparoscopically due to the tumor-positive margin; and in one further patient, leakage was repaired by laparoscopic suturing on the 1st postoperative day. There were no other major complications and no deaths. The hospital stay ranged from 6 to 7 days. The maximum follow-up to date in these patients, including a case of leiomyosarcoma, was 42 months. There has been no evidence of tumor recurrence.
Conclusion: The application of laparoscopy to submucosal tumors of the stomach is technically feasible, safe, and useful. It should be considered a viable alternative to open surgery and gastroscopic management because of its low invasiveness and good postoperative results.
Similar content being viewed by others
References
Allan ME, Mehta D, Zelen J, Folger R (1988) Posterior wall gastric leiomyoma: endoscopic tattoing facilitates laparoscopic resection. JSLS 2: 83–84
Baker HL, Good CA (1955) Smooth muscle tumors of the alimentary tract. Am J Roentgenol 74: 246–249
Bandoh T, Isoyama T, Toyoshima H (1993) Submucosal tumors of stomach: a study of 100 operative cases. Surgery 113: 498–506
Basso N, Silecchia G, Pizzuto G, Surgo D, Picconi T, Materia A (1996) Laparoscopic excision of posterior gastric wall leiomyoma. Surg Laparosc Endosc 6: 65–67
Blackstone MO (1984) Endoscopic interpretation. Raven Press, New York, pp 158–169
Chen SS, Chou FF, Eng HL, Chen JJ, Lee CM, Wan YL (1994) Gastric leiomyosarcoma: a clinicopathological review. Eur J Surg 160: 681–687
Crocker DW (1969) Smooth muscle tumors of the stomach. Ann Surg 170: 239–243
Csáky G (1996) Laparoscopic removal of posterior gastric wall polyp through gastrotomy using hand suturing and mechanical abdominal wall retractor. Surg Technol Int 5: 141–146
Cuschieri A (1995) Whither minimal access surgery: tribulations and expectation. Am J Surg 169: 9–19
DiLorenzo N, Sica GS, Gaspari AL (1996) Laparoscopic resection of gastric leiomyosarcoma. Surg Endosc 10: 662–665 DOI: 10.1007/S004649900124
Donova AJ (1986) Benign tumors of the stomach. In: Sabiston DC (ed) Textbook of surgery. WB Saunders, Philadelphia, pp 856–857
Eng-Hen NG, Pollock RE, Munsell MF, Atkinson EN, Romsdahl MM (1992) Prognostic factors influencing survival in gastrointestinal leiomyosarcoma. Ann Surg 215: 68–77
Geis WP, Baxt R, Kim HC (1996) Benign gastric tumors minimally invasive approach. Surg Endosc 10: 407–410 DOI: 10.1007/s004649910076
Golden TH, Stout AP (1941) Smooth muscle tumors of the gatrointestinal tract and retroperitoneum tissues. Surg Gynecol Obstet 73: 784–810
Gurbuz AT, Peetz MZ (1997) Brief clinical report: resection of a gastric leiomyoma using combined laparoscopic and gastroscopic approach. Surg Endosc 11: 285–286 DOI: 10.1007/s004649900346
Hedenbro JL, Ekelund M, Wetterberg P (1981) Endoscopic diagnosis of submucosal gastric lesions. Surg Endosc 5: 20–23
Katai H, Sasako M, Sano T, Maruyama K (1997) Wedge resection of the stomach for gastric leiomyosarcoma. Br J Surg 84: 560–561
Kavlie H, White TT (1972) Leiomyomas of the upper gastrointestinal tract. Surgery 71: 842–848
Kim SH, Milson JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazioi VW (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11: 1013–1016 DOI: 10.1007/ s004649900514
Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billrofh I gastrectomy. Surg Laparosc Endosc 4: 146–148
Lacy AM, Tabet J, Grandl L, Garcia-Valdecasas JC, Fuster J, Delgado S, Visa J (1995) Laparoscopic-assisted resection of a gastric lipoma. Surg Endosc 9: 995–997
Llorente J (1994) Laparoscopic gastric resection for gastric leiomyoma. Surg Endosc 8: 887–889
Mori T, Atomi Y, Bhoyurl S, Way LW (1995) Intraluminal surgery: a new arena for minimally surgery In: Szabo’z Z, Lewis JE, Fantini GA (eds) Surgical technology international III. Universal Medical Press, Inc., San Francisco, CA, pp 129–134
Motson RW, Fisher DW, Dawson JW (1995) Laparoscopic resection of a benign intragastric stromal tumor. Br J Surg 82: 1670
Ohashi S (1994) Laparoscopic intra-gastric surgery for early gastric cancer: a new technique in laparoscopic surgery. In: Szabo’z Z, Lewis JE, Fantini GA (eds) Surgical technology international III. Universal Medical Press, Inc., San Francisco, CA, pp 221–226
Ohashi S, Yoden YY, Kanno HK, Tei K, Akashi A, Haque M (1995) Laparoscopic gastrotomy in intragastric surgery for early gastric cancer: a new technique. Surgical technology international IV Universal Medical Press, Inc., San Francisco, CA, pp 147–152
Ohgami M, Kumai K, Otani Y, Wakabayashi G, Kubota T, Kitajima M (1994) Laparoscopic wedge resection of the stomach for early gastric cancer using a lesion-lifting method. Dig Surg 11: 64–67
Ohgami M, Otani Y, Kumai K, Kubota T, Kitajima M (1996) Laparoscopic wedge resection of the stomach for early gastric cancer: preliminary report of 27 cases. Asian J Surg 20: 104–107
Payne WG, Murphy CG, Grossbard LJ (1991) Combined laparoscopic and endoscopic approach to resection of gastric leiomyma. J Laparoendosc Surg 5: 119–122
Ripstein CB, Flint GW (1952) Leiomyosarcoma of the gastrointestinal tract. Gastroenterology 20: 315–326
Schiu MH, Farr GH, Papachistou DN, Hajdu SI (1982) Myosarcoma of the stomach; natural history, prognostic factors and management. Cancer 49: 177–187
Seelig MH, Hinder RA, Floch NR, Klingler PJ, Seelig SK, Branton SA, Woodward TA (1999) Endo-organ and laparoscopic management of gastric leiomyomas. Surg Laparosc Endosc 9: 78–81
Senewiratne S, Strong R, Reasbeck PG (1987) Smooth muscle tumors of the upper gastrointestinal tract. Aust N Z J Surg 57: 299–302
Skandalakis JE, Gray SW, Shepard D (1960) Smooth muscle tumor of the stomach. Int Abst Surg 110: 209–226
Stavorovsky M, Morag B, Stavorosky H, Papo J (1983) Smooth muscle tumors of the alimentary tract. J Surg Oncol 22: 109–114
Strohm WD, Classen M (1986) Benign lesions of the upper GI tract by means of endoscopic ultrasonography. Scand J Gastroenterol 21 (Suppl 123): 41–46
Stroker ME, Vose J, O’Mara P, Maini BS (1992) Laparoscopic cholecystectomy. Arch Surg 5: 589–595
Taniguchi E, Kamiike W, Yamanishi H, Ito T, Nezur Nishida T, Momiyama T, Ohashi S, Okada T, Matsuda H (1997) Laparoscopic intragastric surgery for gastric leiomyoma. Surg Endosc 11: 287–289 DOI: 10.1007/s004649900347
Tio TL (1988) Endosonography in gastroenterology. Springer, Berlin, Heidelberg, New York, pp 104–116
Trias M, Taragarona EM, Balague C, Bordas JM, Cirera I (1996) Endoscopically assisted laparoscopic partial gastric resection for treatment of a large benign gastric adenoma. Surg Endosc 10: 344–346 DOI: 10.1007/s004649910058
Watson DI, Game PA, Devitt PG (1996) Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc 10: 540–541 DOI: 10.1007/s004649900108
Yamashita Y, Bekki F, Kakegawa T, Umetani H, Yatsuka K (1995) Two laparoscopic techniques for resection of leiomyoma in the stomach. Surg Laparosc Endosc 5: 38–42
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 DOI: 10.1007/s002689900255
Author information
Authors and Affiliations
Additional information
Online publication: 13 June 2000
Rights and permissions
About this article
Cite this article
Choi, Y.B., Oh, S.T. Laparoscopy in the management of gastric submucosal tumors. Surg Endosc 14, 741–745 (2000). https://doi.org/10.1007/s004640000148
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640000148