Laparo-endoscopic transgastric resection of gastric submucosal tumors

Abstract

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.

Preliminary analysis of hybrid laparoscopic procedure for resection of gastric submucosal tumors

“…As for length of stay, the study of De Vogelaere et al 14 reported seven days for the laparoscopy group was compared with 14 days for the open group 4 . In our study, the length of stay was on average 3.5 days, below the average of studies found 7,14,15 . Other works also demonstrate lower incidence of post-operative pain, smaller wound size, early return of bowel function with return to normal diet and shorter postoperative hospital stay 15,16 .…”

“…Thus, some authors recommend open surgery for such locations. Recently, to prevent deformity or stenosis of these areas, several minimally invasive techniques with organ preservation are being developed 1,7,11,13 .…”

Gastric sub-epithelial tumors: identification of gastrointestinal stromal tumors using CT with a practical scoring method

“…Curative surgical resection is required for cure of gastric GISTs due to the high malignant potentials [2,3]. In contrast, almost all gastric non-GISTs SETs, mainly consist of leiomyoma and schwannoma [4,5], are benign and remain stable [4], so conservative medical management or less-invasive resection approach is usually recommended and performed [6,7]. Therefore, the accurate pre-operative differentiation of gastric GISTs from non-GISTs is of great importance for patients care and decision making [8].…”

Laparoscopic transgastric resection of gastric submucosal tumor located near the esophagogastric junction

“…These approaches include tumor enucleation, exogastric wedge resection, transgastric tumor-everting resection, intragastric tumor everting resection, laparoscopic and endoscopic cooperative surgery and esophagogastrectomy [8][9][10][11] .…”