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Full-thickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach

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Abstract

Background

Until now, the conventional treatment of stromal tumors has been primarily open surgery or laparoscopic excision. The use of combined laparoscopic/endoscopic surgeries has been investigated, but endoscopic therapy alone has been limited to en bloc resection or nucleus removal of intracavitary tumors with diameters <2 cm. Nonintracavitary and intramural gastric stromal tumors preclude the use of endoscopic resection due to the risk of gastric perforation. This study was designed to show the safety and effectiveness of full-thickness endoscopic resection of nonintracavitary stromal tumors based on our direct experience.

Methods

A total of 109 consecutive patients with nonintracavitary gastric stromal tumors <4 cm in diameter underwent surgical treatment; 66 patients received endoscopic surgery and 43 patients received laparoscopic surgery.

Results

No significant differences existed between the two groups in terms of demographics and clinical characteristics, and no tumor exceeded 3.5 cm in size. Median operation times (endoscopic group, 53.6 min; laparoscopic group, 139 min) and hospitalization fees of the endoscopic group were significantly lower than those of the laparoscopic group with significant median hospital stays (8 days for endoscopic group; 6 days for laparoscopic group). No intraoperative complications occurred in the laparoscopic group and complete removal of tumors was achieved in the endoscopic group. Postoperative complications occurred in 6 patients of 43 who underwent laparoscopic surgery and 17 patients of 66 who underwent endoscopic surgery, representing a significant difference; the size of the lesion correlated positively with the occurrence of complications.

Conclusions

Endoscopic resection is safe and effective for treating nonintracavitary stromal tumors. The endoscopic natural-cavity technique produced less surgical injury to the patients and preserved the anatomy of intra-abdominal structures. In addition, the endoscopic technique reduced operative times, postoperative bleeding, and costs.

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References

  1. Franzini C, Alessandri L, Piscioli I, Donato S, Faraci R, Morelli L, Del Nonno F, Licci S (2008) Extra-gastrointestinal stromal tumour of the greater omentum: report of a case and review of the literature. World J Surg Oncol 23:25

    Article  Google Scholar 

  2. La Greca G, Randazzo V, Barbagallo F, Gagliardo S, Sofia M, Chisari A, Latteri S, Russello D (2008) Laparoscopic resection of a large GIST of the stomach: is it preferable in elderly patients? A case report. Chir Ital 60:135–139

    PubMed  Google Scholar 

  3. Li VK, Hung WK, Chung CK, Ying MW, Lam BY, Kan DM, Chan MC (2008) Laparoscopic intragastric approach for stromal tumours located at the posterior gastric wall. Asian J Surg 31:6–10

    Article  PubMed  Google Scholar 

  4. Gelmini R, Bertolini F, Rossi G, Luppi G, Saviano M, Conte PF (2007) Laparoscopic approach of gastric gastrointestinal stromal tumors (GISTs): is it still a courageous choice? Report of two cases. Surg Laparosc Endosc Percutan Tech 17:133–137

    Article  PubMed  Google Scholar 

  5. Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, Brunt LM, Frisella MM, Matthews BD (2008) Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc 22:2583–2587 (epub 2008 Mar 6)

    Article  PubMed  Google Scholar 

  6. Fang FC, Tzao C, Cheng YL, Chan DC, Nieh S, Lee SC (2007) Surgical treatment of gastrointestinal stromal tumor in the esophagus: report of three cases. Z Gastroenterol 45:1252–1256

    Article  PubMed  Google Scholar 

  7. Li CJ, Huang MT, Chen CS, Tam KW, Chai CY, Wu CH (2007) Application of laparoscopic techniques for resection of individual gastric submucosal tumors. Surg Laparosc Endosc Percutan Tech 17:425–429

    Article  CAS  PubMed  Google Scholar 

  8. Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, Pantaleo M, Biasco G, Caletti G, Pinna A (2008) Laparoscopic treatment of gastric GIST: report of 21 cases and literature review. J Gastrointest Surg 12:561–568

    Article  PubMed  Google Scholar 

  9. Khashab MA, Crammer HM, Liangpunsakul S (2007) Role of hemoclips in the management of acute bleeding from a gastric stromal tumor: a case report and review of the literature. J Med Case Reports 1:136

    Article  PubMed  Google Scholar 

  10. Bogoevski D, Mann O, Schurr P, Izbicki JR, Strate T (2007) Laparoscopic gastric tailoring for huge subcardial gastrointestinal stromal tumor. JSLS 11:394–397

    CAS  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Miki A, Ohyama S, Seto Y (2008) Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 22:1729–1735 (epub 2007 Dec 12)

    Article  CAS  PubMed  Google Scholar 

  13. Cavaliere D, Vagliasindi A, Mura G, Framarini M, Giorgetti G, Solfrini G, Tauceri F, Padovani F, Milandri C, Dubini A, Ridolfi L, Ricci E, Verdecchia GM (2007) Downstaging of a gastric GIST by neoadjuvant imatinib and endoscopic assisted laparoscopic resection. Eur J Surg Oncol 33:1044–1046 (epub 2007 Apr 30)

    CAS  PubMed  Google Scholar 

  14. von Renteln D, Riecken B, Walz B, Muehleisen H, Caca K (2008) Endoscopic GIST resection using FlushKnife ESD and subsequent perforation closure by means of endoscopic full-thickness suturing. Endoscopy 40(Suppl 2):E224–E225 (epub 2008 Sep 25)

    Article  Google Scholar 

  15. Zhou PH, Yao LQ, Qin XY (2008) Endoscopic submucosal dissection for gastrointestinal stromal tumors: a report of 20 cases. Zhonghua Wei Chang Wai Ke Za Zhi 11:219–222

    PubMed  Google Scholar 

  16. Katoh T, Itoh Y, Mohri T, Suzuki H (2008) Endoscopic enucleation of gastrointestinal stromal tumors of the stomach: report of five cases. World J Gastroenterol 14:2609–2611

    Article  PubMed  Google Scholar 

  17. Luo W, Wang Z, Li P, Zeng S, Luo Q (2008) A modified mini-stroke model with region-directed reperfusion in rat cortex. J Cereb Blood Flow Metab 28:973–983 (epub 2007 Dec 12)

    Article  PubMed  Google Scholar 

  18. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826

    Article  PubMed  Google Scholar 

  19. McGee MF, Schomisch SJ, Marks JM, Delaney C, Jin J, Williams C, Chak A, Andrews J, Ponsky J (2007) Systemic inflammation and physiologic burden of transgastric natural orifice translumenal endoscopic surgery (NOTES) peritoneoscopy: a controlled, prospective comparison between NOTES and laparoscopy. Gastrointest Endosc 65:AB127

    Google Scholar 

  20. Swain P (2007) A justification for NOTES—natural orifice translumenal endosurgery. Gastrointest Endosc 65:514–516

    Article  PubMed  Google Scholar 

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Disclosures

Drs. Lei Wang, Wei Ren, Chao-qiang Fan, Yi-hui Li, Xia Zhang, Jin Yu, Guo-ce Zhao, and Xiao-yan Zhao have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, 1# Xinqiao Street, Chongqing, 400037, China

    Lei Wang, Wei Ren, Chao-qiang Fan, Yi-hui Li, Xia Zhang, Jin Yu, Guo-ce Zhao & Xiao-yan Zhao

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  1. Lei Wang
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  2. Wei Ren
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  3. Chao-qiang Fan
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  4. Yi-hui Li
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  5. Xia Zhang
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  6. Jin Yu
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  7. Guo-ce Zhao
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  8. Xiao-yan Zhao
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Corresponding author

Correspondence to Xiao-yan Zhao.

Additional information

Lei Wang and Wei Ren contributed equally to this study.

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Wang, L., Ren, W., Fan, Cq. et al. Full-thickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach. Surg Endosc 25, 641–647 (2011). https://doi.org/10.1007/s00464-010-1189-5

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  • DOI: https://doi.org/10.1007/s00464-010-1189-5

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