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

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

doi:10.1007/s00464-012-2374-5

Cited by 42 publications

(21 citation statements)

References 28 publications

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“…The principles for the surgical treatment of SMTs have been previously described by different authors and are available in the current guidelines: achievement of negative margins both macroscopically and microscopically, a complete resection of the tumor with low risk of tumor rupture and potential peritoneal seeding, and no lymphadenectomy due to the rare involvement of lymph nodes [27, 28]. On the other hand, it is also affirmed that the survival of patients with these tumors is related with tumor size and histological composition and not associated with microscopic margins of resection, allowing an expanded role for MIS procedures [29].…”

Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic transgastric resection of gastric submucosal tumors

et al. 2014

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Background Laparoscopic and endoluminal surgical techniques have evolved and allowed improvements in the methods for treating benign and malignant gastrointestinal diseases. To date, only case reports have been reported on the application of a laparo-endoscopic approach for resecting gastric submucosal tumors (SMT). In this study, we aimed to evaluate the efficacy, safety, and oncologic outcomes of a laparo-endoscopic transgastric approach to resect tumors that would traditionally require either a laparoscopic or open surgical approach. Herein, we present the largest single institution series utilizing this technique for the resection of gastric SMT in North America. Methods We performed a retrospective review of a prospectively collected patient database. Patients who presented for evaluation of gastric SMT were offered this surgical procedure and informed consents were obtained for participation in the study. Results Fourteen patients were included in this study between August/2010 and January/2013. Eight (8) patients (57.1 %) were female and the median age was 56 years (range 29–78). Of the 14 cases, 8 patients (57.1 %) underwent laparo-endoscopic resection of SMTs with transgastric extraction, 5 patients (35.7 %) had conversions to traditional laparoscopic surgery, and 1 patient (7.2 %) was abandoned intraoperatively. The median operative time for this cohort was 80 min (range 35–167). Ten patients (71.4 %) had GISTs, 3 (21.4 %) had leiomyomas, and 1 (7.1 %) had schwannoma. There were no intraoperative complications. Two patients had postoperative staple line bleeding that required repeat endoscopy. The median hospital stay was 1 day (range 1–6) and there were no postoperative mortalities. At 12-month follow-up visit, only one GIST patient (10 %) had tumor recurrence. Conclusion Our experience suggests that this surgical approach is safe and efficient in the resection of gastric SMT with transgastric extraction. This study found no intraoperative complications and optimal oncologic outcomes during the follow-up period. Minimally invasive surgical approaches are emerging as a valid and potentially better approach for resecting malignancies; however, continued investigation is underway to further validate this data.

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Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic transgastric resection of gastric submucosal tumors

et al. 2014

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“…When the tumor grows extra-gastrically and presents without mucosal ulceration, a purely laparoscopic operation is considered. However, special attention should be paid to GEJ, cardia and prepyloric tumors, which are perhaps the most difficult tumor locations to approach via laparoscopic techniques because of the risk of narrowing the GEJ, gastroesophageal reflux and stenosis, both GEJ and pyloric, after removal [14]. In that case, purely endoscopic enucleation or combined laparoendoscopic technique may be applied.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, GISTs located in proximity to the gastroesophageal junction (GEJ) or at the cardia can prove challenging to manage laparoscopically as the deformity after resection of such lesions can result in gastroesophageal reflux or late stenosis. Gastrointestinal stromal tumors involving the prepyloric part of the stomach have also been reported to be difficult to remove using minimally invasive technique [14]. …”

Section: Introductionmentioning

confidence: 99%

Surgical management of gastrointestinal stromal tumors: a single center experience.

Poškus¹,

Petrik²,

Petrik³

et al. 2014

Videosurgery and Other Miniinvasive Techniques

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IntroductionGastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection.AimTo provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs.Material and methodsWe retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed.ResultsForty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively.ConclusionsLaparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.

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“…A GIST's tendency to grow in an exophytic manner has led the surgical community to attempt resection using laparoscopic technology. The updated NCCN task force on GISTs recommends laparoscopic tumor excision for lesions up to 5 cm [24]. In terms of location, it has been proposed that laparoscopic wedge resection is indicated for tumors located in the anterior stomach.…”

Section: Discussionmentioning

confidence: 99%