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Laparoscopic approaches to gastric gastrointestinal stromal tumors: an institutional review of 57 cases

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Abstract

Introduction

Gastrointestinal stromal tumors (GIST) are uncommon gastric neoplasms, which are typically treated by surgical excision. During the past 10 years, our institution has gained experience in resecting these tumors by minimally invasive methods. The purpose of this study is to review our experience with laparoscopic resection, report our short-term outcomes, and offer our perspective on the technical nuances involved in handling these neoplasms.

Methods

We retrospectively queried our prospectively maintained, institutional review board-approved database for all gastric GISTs resected from 2002 to 2012. We analyzed all cases that were resected via laparoscopy. Operative notes were reviewed for the technique employed. Data on tumor location, size, margin status, operative time, and blood loss were collected and analyzed.

Results

During the 10-year study period, 104 gastric GISTs were resected. Laparoscopy was attempted in 58 cases with only one conversion to an open procedure. Tumors were separated based on anatomic zones. Forty-seven tumors (82  %) were located on the body or fundus of the stomach (18 on the posterior wall and 29 on the anterior wall). Five GISTs (9 %) were located at the gastroesophageal junction (GEJ). Five tumors (9 %) were located at the antrum. The mean tumor size was 3.8 cm with a mean estimated blood loss of 40 ml. We achieved R0 resection in 100 % of the cases. Most tumors (96 %) were amenable to wedge resection. Tumors at the extremes of the stomach required variations of technique to achieve resection. Intraoperative endoscopy was selectively utilized.

Conclusions

As our experience with gastric GISTs has increased, laparoscopic resection has become our first-line treatment for most small- and moderate-sized tumors. By employing a structured approach to tumors along the entire stomach, laparoscopic resection of these tumors can be performed safely with adequate short-term results.

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Acknowledgments

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Disclosures

Drs. Michael Pucci, Adam Berger, Pei-Wen Lim, Karen Chojnacki, Ernest Rosato, and Francesco Palazzo have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, Thomas Jefferson University, Fifth Floor Medical Office Building, 1100 Walnut Street, Philadelphia, PA, 19107, USA

    Michael J. Pucci, Adam C. Berger, Pei-Wen Lim, Karen A. Chojnacki, Ernest L. Rosato & Francesco Palazzo

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  1. Michael J. Pucci
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  2. Adam C. Berger
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  3. Pei-Wen Lim
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  4. Karen A. Chojnacki
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  6. Francesco Palazzo
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Correspondence to Francesco Palazzo.

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Pucci, M.J., Berger, A.C., Lim, PW. et al. Laparoscopic approaches to gastric gastrointestinal stromal tumors: an institutional review of 57 cases. Surg Endosc 26, 3509–3514 (2012). https://doi.org/10.1007/s00464-012-2374-5

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  • DOI: https://doi.org/10.1007/s00464-012-2374-5

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