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Laparoscopic resection of gastrointestinal stromal tumors

Not all tumors are created equal

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Abstract

Background

Laparoscopic resection has become an accepted approach to gastrointestinal stromal tumors (GISTs), with acceptable early results published in the literature. Long-term recurrence rates, however, are still unclear, and the management of tumors in challenging locations requires exploration.

Methods

A retrospective analysis of all patients undergoing a laparoscopic resection of gastric GIST in our institution between November 1997 and July 2004 was performed.

Results

A total of 14 patients with 15 tumors were evaluated, 5 of which were located high on the lesser curve. All the patients had an attempted laparoscopic approach, with the following procedures performed: stapled wedge excision (n = 8), excision and manual sewing technique (n = 4), and distal gastrectomy (n = 1). Overall, there was a 15% (n = 2) conversion rate. Lesions found in the fundus and greater curvature areas were easily resected via simple stapled wedge excision. High lesser curve tumors were more difficult to manage and required a combination of methods for complete excision and preservation of the gastrointestinal junction including intraoperative gastroscopy, excision and manual sewing technique, and reconstruction over an esophageal bougie. There were no postoperative complications, and the length of hospital stay was 4.6 ± 1.9 days. At a median follow-up period of 46.5 months (mean, 37.4 ± 26 months), one patient experienced a recurrence (18 months postoperatively), with eventual disease-related death.

Conclusion

The laparoscopic approach to gastric GIST tumors is safe and associated with acceptable short- and intermediate-term results. High lesser curve GISTs can be safely approached laparoscopically using various techniques to ensure an adequate resection margin without compromise of the GE junction.

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Acknowledgments

The authors thank Ms. Cybelle Fernandez for her aid in data collection and analysis.

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Authors and Affiliations

  1. St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada

    E. L. R. Bédard, J. Mamazza, C. M. Schlachta & E. C. Poulin

  2. Division of General Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, CPC—Suite 121, Ottawa, Ontario, K1Y 4E9, Canada

    J. Mamazza

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  1. E. L. R. Bédard
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  2. J. Mamazza
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  3. C. M. Schlachta
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  4. E. C. Poulin
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Correspondence to J. Mamazza.

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Bédard, E.L.R., Mamazza, J., Schlachta, C.M. et al. Laparoscopic resection of gastrointestinal stromal tumors. Surg Endosc 20, 500–503 (2006). https://doi.org/10.1007/s00464-005-0287-2

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  • DOI: https://doi.org/10.1007/s00464-005-0287-2

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