Laparoscopic management of gastric gastrointestinal stromal tumors: A retrospective 10-year single-center experience

Abstract

AIMTo determine the feasibility, safety, and oncological outcome of laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) based on favorable or unfavorable location.METHODSOur hospital database included 207 patients who underwent laparoscopic removal of gastric GISTs from January 2004 to September 2015. Patient demographics, clinical presentation, surgery, histopathology, postoperative course, and oncological outcomes were reviewed and analyzed.RESULTSGastric GIST in favorable locations was present in 81/207 (39.1%) cases, and in unfavorable locations in 126/207 (60.9%) cases. Overall mean tumor size was 3.28 ± 1.82 cm. No conversions occurred, and complete R0 resection was achieved in 207 (100%) cases. There were three incidences of iatrogenic tumor rupture. The feasibility and safety of laparoscopic surgery were comparable in both groups with no statistical difference between unfavorable and favorable location groups, respectively: for operative time: 83.86 ± 44.41 vs 80.77 ± 36.46 min, P = 0.627; conversion rate: 0% vs 0%; estimated blood loss: 27.74 ± 45.2 vs 29.59 ± 41.18 mL, P = 0.780; tumor rupture during surgery: 0.90% vs 2.82%, P = 0.322; or postoperative complications: 3.74% vs 7.04%, P = 0.325. The follow-up period recurrence rate was 1.89% with no significant differences between the two groups (3.03% vs 0%, P = 0.447). Overall 5-year survival rate was 98.76% and survival rates were similar between the two groups: 98.99% vs 98.39%, P = 0.623 (unfavorable vs favorable, respectively).CONCLUSIONThe laparoscopic approach for gastric GISTs is safe and feasible with well-accepted oncological surgical outcomes. Strategies for laparoscopic resection should be selected according to the location and size of the tumor. Laparoscopic treatment of gastric GISTs in unfavorable locations should not be restricted in gastrointestinal centers.

Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor

“…Laparoscopic wedge resection with or without (eversion technique, as shown in this study) a stapler is the most common and fundamental operative technique, especially for extraluminal G‐SMT located on the gastric body or the greater curvature . As to tumors located near the esophagogastric junction, p‐ring, or on the side of the lesser curvature, this procedure can increase the risk of generating stenosis or deformity in the gastric inlet or outlet . The eversion technique by opening the gastric lumen can involve the potential risk of tumor cell seeding, particularly in patients with GIST with ulceration .…”

“…In fact, EFTR with complete closure of the gastric‐wall defect using endoclips could be carried out for the lesser/greater curvature side. Conversely, it is inevitable and relatively difficult to operate on lesions located in the lesser curvature side (from the pyloric ring to the cardia) . LR, except for intragastric surgery, requires resection of the attachment of the omentum to the stomach in the excision area to remove the tumor.…”

“…16,18 As to tumors located near the esophagogastric junction, p-ring, or on the side of the lesser curvature, this procedure can increase the risk of generating stenosis or deformity in the gastric inlet or outlet. 21 The eversion technique by opening the gastric lumen can involve the potential risk of tumor cell seeding, particularly in patients with GIST with ulceration. 22 However, a recent study showed that this style of surgery did not increase the risk of dissemination even in GIST with ulceration.…”

Surgical treatment of gastric GIST with acute bleeding using laparoscopic sleeve gastrectomy: A report of two cases

“…Limitations about the feasibility of laparoscopy in the surgical treatment of gastric GISTs can be related to the location and the size of the tumor. In the most recent guidelines of the European Society for Medical Oncology, the National Comprehensive Cancer Network (NCCN), and the Asian GIST guidelines, the indication for laparoscopic resection is reduced for lesions in the greater curvature and anterior wall of the gastric body, fundus, and antrum . For those of the lesser curvature, the cardia and the prepyloric region and the risks of stenosis of the lumen postoperatively or nononcological resections in addition to the difficulty in exposing the tumor affect negatively the choice of a laparoscopic approach.…”

“…In the most recent guidelines of the European Society for Medical Oncology, the National Comprehensive Cancer Network (NCCN), and the Asian GIST guidelines, the indication for laparoscopic resection is reduced for lesions in the greater curvature and anterior wall of the gastric body, fundus, and antrum. 11 For those of the lesser curvature, the cardia and the prepyloric region and the risks of stenosis of the lumen postoperatively or nononcological resections in addition to the difficulty in exposing the tumor affect negatively the choice of a laparoscopic approach. Concerning the limit of tumor's size, several retrospective cohort studies have suggested that laparoscopic resection is feasible and safe for gastric GISTs smaller than 5 cm.…”