Application of an individualized operative strategy for wedge resection of gastric gastrointestinal stromal tumors: Effectiveness for tumors in difficult locations

Mueller, Carmen L.; Braun, J.; Leimanis, Mara L.; Mouhanna, Jack; Feldman, Liane S.; Ferri, Lorenzo

doi:10.1016/j.surg.2016.06.004

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…Tumor size should not be considered a limitation for experienced laparoscopic surgeons using the no-touch technique. Recent retrospective studies showed that laparoscopic surgery did not increase the risks of tumor relapse and metastasis[9,11]. Laparoscopic surgery should be considered as a standard approach in all cases irrespective of tumor size.…”

Section: Discussionmentioning

confidence: 99%

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

Liao¹,

Chen²,

Qi³

et al. 2017

WJG

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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.

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Section: Discussionmentioning

confidence: 99%

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

Liao¹,

Chen²,

Qi³

et al. 2017

WJG

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“…In that study, over 40% of the cases presented were located in the lesser curve, antrum or cardiac. Wedge resection guided by intraoperative endoscopy resulted in a 100% R0 resection with similarly favorable perioperative and long term oncological outcomes, where over 95% 5-year overall survival was achieved (16). More complex approaches such as the intragastric or "endoluminal" surgery through the use of intra-gastric working ports have also been described for challenging locations such as posterior wall gastric GISTs (17,18).…”

Section: Resection For Tumors In Difficult Locationsmentioning

confidence: 99%

Minimally invasive surgery for gastric gastrointestinal stromal tumors

Koh

Goh

2017

Transl. Gastroenterol. Hepatol.

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Minimally invasive surgery has been increasingly performed for gastric gastrointestinal stromal tumors (GIST). In this review we discuss and summarize the current evidence on minimally invasive surgery for gastric GISTs. Laparoscopic resection for gastric GIST has been consistently shown to be associated with superior perioperative outcomes with no compromise in oncological outcomes when compared to open resection in numerous retrospective case-control studies. It has also been shown to be safe and feasible for large tumors or tumors located in unfavorable sites. However, to date, there remains a lack of level 1 evidence from prospective randomized control trials in support of laparoscopic resection.

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“…These industries have also been at the forefront in recognising the importance of human factors, in particular non-technical skills, as complementary to technical skills in improving safety, and therefore integrate non-technical skills practice and debrief into simulator-based exercises. Raghavendra and colleagues (2016) concluded that non-technical skills positively correlated with technical skills to improve overall surgical resident performance. More recently, the oil and gas industry has recognised the critical impact of non-technical skills, and technological developments in high fidelity drilling simulators has led to increased opportunities to practise, test out and receive feedback on both technical and non-technical skills during training courses.…”

Section: Introductionmentioning

confidence: 99%

Developing a Team Behavioural Marker Framework Using Observations of Simulator-Based Exercises to Improve Team Effectiveness: A Drilling Team Case Study

Crichton

Moffat

Crichton

2017

Simulation & Gaming

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Background. Due to the challenge of conducting observations of drilling team behaviours on an offshore installation during actual operations, a high fidelity simulator provided the opportunity to observe team behaviours when managing complex and uncertain situations. Aim. This article describes how such observations were used to develop a team behavioural marker framework subsequently used for debriefing. Method. Team behaviours and interactions were recorded during 25 simulator-based training exercises which had been integrated into a technical training course. These were then analysed, and four dimensions, with example behaviours, were identified. Results. The behavioural markers formed the basis of training objectives, and provided structure for debriefing team performance. The use of the simulator provided concrete examples of both effective and ineffective behaviours. Conclusions. Notable improvements in drilling team interactions and behaviours were noted over the course of five exercises, which ranged in complexity and uncertainty, throughout the training course. Enhancing team non-technical skills will lead to safer and more effective performance, and facilitate the transfer from training to actual operations. Team members also became more familiar with the concepts and terminology of non-technical skills and integrated behavioural markers into workplace practices such as Tool Box Talks, Stop Work Authority, and Time-Outs.

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Application of an individualized operative strategy for wedge resection of gastric gastrointestinal stromal tumors: Effectiveness for tumors in difficult locations

Cited by 8 publications

References 26 publications

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

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

Minimally invasive surgery for gastric gastrointestinal stromal tumors

Developing a Team Behavioural Marker Framework Using Observations of Simulator-Based Exercises to Improve Team Effectiveness: A Drilling Team Case Study

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