Gastric liposarcoma resected by laparoscopic total gastrectomy to achieve a wide surgical margin

Abstract

Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top. Our preoperative diagnosis was lipoma, and we performed laparoscopic intragastric surgery. However, the histopathological diagnosis was liposarcoma. Laparoscopic total gastrectomy was performed to achieve a wide surgical margin. Several recent series have shown that a positive microscopic margin is associated with a higher rate of local recurrence than a negative margin. We have added a staged operation to obtain a wide margin in cases involving a positive surgical margin. Preoperative diagnosis of liposarcoma is still challenging. Gastric lipoma-like tumours should be resected with a wide margin because of their possibility of malignancy.

Laparoscopic management of gastric liposarcoma: A case report and review of the literature

“…The undifferentiated type is a high-grade sarcoma. It is very common in the retroperitoneal región [ 7 ]; they usually have areas of hemorrhage and necrosis together with solid areas. Due to this, it can be misdiagnosed as the pleomorphic type.…”

Gastric liposarcoma treated successfully with partial gastrectomy

“…Tumors arising from visceral organs tend to carry a higher mortality rate compared to isolated extremity tumors [5]. Local recurrence can be as high as 60-100% at five years [6,7]. Distant metastasis depends largely on the grade of the sarcoma.…”

“…The extent of dissection depends on the ability to achieve wide margins of healthy tissue for an R0 resection [10]. Even for well-differentiated sarcomas that have lower local recurrence rates, five year disease-free survival is worse in the setting of microscopically-positive margins [6]. Frozen sections have been used successfully to ensure disease-free margins [5].…”

“…Frozen sections have been used successfully to ensure disease-free margins [5]. Several surgeons from Japan describe their experience performing laparoscopic intragastric surgery for a 5 cm tumor in the gastric fundus, however their margins were positive and the patient eventually required a total gastrectomy [6]. Intragastric surgery is best suited for well-encapsulated, submucosal lesions in close proximity to the gastro-esophageal junction.…”

Gastric lipoma of the pylorus – case report of an incidental finding

“…Gastric lipomas are solitary in 75% of the described cases and are most frequently located in the gastric antrum. They tend to be submucosal rather than subserosal [4] , [5] , [6] . Management of symptomatic lipomas is traditionally endoscopic excision in small lesions with larger lesions undergoing classical surgery, although this is debated [5] , [6] , [7] .…”