Short-term outcomes of laparoscopic local resection for gastric submucosal tumors: a single-center experience of 266 patients

Abstract

BackgroundLaparoscopic resections for submucosal tumors (SMTs) of the stomach have been developed rapidly over the past decade. Several types of laparoscopic methods for gastric SMTs have been created. We assessed the short-term outcomes of two commonly used types of laparoscopic local resection (LLR) for gastric SMTs and reported our findings.MethodsWe retrospectively analyzed the clinicopathological results of 266 patients with gastric SMTs whom underwent LLR between January 2006 and September 2016. 228 of these underwent laparoscopic exogastric wedge resection (LEWR), the remaining 38 patients with the tumors near the esophagogastric junction (EGJ) or antrum underwent laparoscopic transgastric resection (LTR).ResultsAll the patients underwent laparoscopic resections successfully. The mean operation times of LEWR and LTR were 90.2 ± 37.2 min and 101.7 ± 38.5 min respectively. The postoperative length of hospital stays for LEWR and LTR were 5.1 ± 2.1 days and 5.3 ± 1.7 days respectively. There was a low complication rate (4.4%) and zero mortality in our series.ConclusionELWR is technically feasible therapy of gastric SMTs. LTR is secure and effective for gastric intraluminal SMTs located near the EGJ or antrum.

Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor

“…The laparoscopic exo‐gastric approach includes wedge resection and CLEAN‐NET (combination of laparoscopic and endoscopic approaches to neoplasia with non‐exposure technique) . 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 .…”

“…1,2 Although many minimally invasive procedures are available for the removal of small (<50 mm) G-SMT, there is no consensus regarding the resection method, because the choice can be influenced by many factors, such as surgeon's preference and experience, the institution's policy, and patient/tumor characteristics. 16,18 However, the goal of these procedures is the same, namely, complete tumor removal with minimum resection of the normal stomach, a clear margin and no pseudocapsule rupture. At present, the resection procedures can roughly be divided into four types of approach, namely, laparoscopic exo-gastric, via-gastrotomy, hybrid, and endoscopic approaches.…”

“…19,20 Laparoscopic wedge resection with or without (eversion technique, 16 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. 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.…”

“…19,20,23,24 There is another laparoscopic technique designed to resect tumors by gastrotomy, which can be divided into two types of surgery, transgastric and intragastric surgery. 18,25,26 In transgastric surgery, an anterior gastric incision is made, and the tumor is removed under a good visual field through the incision. 18 Intragastric surgery involves direct introduction of the ports into the gastric cavity and removal of the tumor intragastrically.…”

“…18,25,26 In transgastric surgery, an anterior gastric incision is made, and the tumor is removed under a good visual field through the incision. 18 Intragastric surgery involves direct introduction of the ports into the gastric cavity and removal of the tumor intragastrically. 25,26 This surgery is not so popular, but causes no damage to the perigastric tissue and has a minimum risk of deformity.…”