Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery

Ojima, Toshiyasu; Nakamura, Masaki; Nakamori, Mikihito; Takifuji, Katsunari; Hayata, Keiji; Katsuda, Masahiro; Takei, Yoh; Yamaue, Hiroki

doi:10.1007/s00464-017-5683-x

Cited by 22 publications

(27 citation statements)

References 23 publications

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“…The resected specimen is placed in a plastic bag (Rusch MemoBag; Teleflex, Tokyo, Japan) and removed intraluminally using endoscopy if the size of the tumor is ≤ 5 cm[ 20 , 80 ]. Larger tumors of > 5 cm are removed trough the umbilicus with a plastic bag.…”

Section: Oral Approach By Endoscopic Visualizationmentioning

confidence: 99%

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Aisu¹,

Yasukawa²,

Kimura³

et al. 2018

WJGO

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Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

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Section: Oral Approach By Endoscopic Visualizationmentioning

confidence: 99%

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Aisu¹,

Yasukawa²,

Kimura³

et al. 2018

WJGO

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“…LECS was first reported by Hiki et al in 2008 [5]. Many studies had demonstrated that LECS is a safe, feasible, and effective procedure for treating gastric GISTs [6–9], especially advantageous in removing the tumor completely without excessive resection of the gastric wall. In recent years, LECS has been considered as a standard treatment for gastric GISTs in Japan [10].…”

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confidence: 99%

Clinical feasibility and safety of third space robotic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumors dissection

Shi

Pan

et al. 2019

Surg Endosc

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BackgroundSurgical management of gastric gastrointestinal stromal tumors (GISTs) has evolved towards minimal invasiveness. Laparoscopic wedge resection and laparoscopic and endoscopic cooperative surgery had been considered as standard surgical treatments for gastric GISTs > 2 cm. However, stomach deformation and the full-thickness gastric defect caused by these procedures may increase the risk of morbidity. To address these problems, we developed a novel technique, third space robotic and endoscopic cooperative surgery (TS-RECS), which could dissect the tumor entirely while preserving the intact mucosal layer. Here we performed a prospective evaluation of the feasibility and safety of TS-RECS.MethodsPatients with gastric GISTs were recruited between April 2018 and April 2019. During the operation, the gastric GIST was located by endoscopic view firstly and the submucosal injection was performed. The tumor was then dissected through robotic surgery. Clinicopathological characteristics, operative data, adverse events, and follow-ups were prospectively collected and analyzed.ResultsA total of 20 patients with gastric GISTs received TS-RECS. The mean tumor size was 33.0 ± 7.3 mm. R0 resection was achieved in all patients with a median operation time of 115 min and a median blood loss of 20 ml. The integrity of mucosal layer was maintained in 95% (19/20) of the patients. All patients started oral diet on postoperative day 1 or 2, staying in the hospital for a median of 6 days after surgery. There were no major adverse events. Local or distant recurrences were not observed during a median follow-up period of 10 months.ConclusionsOur study suggests that TS-RECS appears to be a feasible and safe technique which could be an alternative method for resecting gastric GISTs > 2 cm.Clinical TrialsClinicalTrials.gov NCT03804762.Electronic supplementary materialThe online version of this article (10.1007/s00464-019-07223-w) contains supplementary material, which is available to authorized users.

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“…There were no RCTs or case-control studies. Among these studies, except for the three studies from Korea, [ 5 ] Russia, [ 18 ] and Japan, [ 32 ] all other studies were from China. Tables 1 and 2 display the summaries of each study in this cumulative meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic or laparoscopic resection for small gastrointestinal stromal tumors: a cumulative meta-analysis

Cai

Liang

et al. 2020

Chinese Medical Journal

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Background Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤ 5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection. Methods The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and subgroup analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results. Results A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD] = –27.1 min, 95% confidence interval [CI]: –40.8 min to –13.4 min) and lengths of hospital stay (WMD = –1.43 d, 95% CI: –2.31 d to –0.56 d) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 – 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31 – 25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = –41.03 min, 95% CI: –59.53 min to –22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57 – 10.34). Conclusions In general, endoscopic resection is an alternative method for gastric GISTs ≤ 5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.

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Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery

Cited by 22 publications

References 23 publications

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Clinical feasibility and safety of third space robotic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumors dissection

Endoscopic or laparoscopic resection for small gastrointestinal stromal tumors: a cumulative meta-analysis

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