Deciding Laparoscopic Approaches for Wedge Resection in Gastric Submucosal Tumors: A Suggestive Flow Chart Using Three Major Determinants

Lee, Chung Ho; Hyun, Myung Han; Kwon, Yong; Cho, Sung-Il

doi:10.1016/j.jamcollsurg.2012.07.009

Cited by 25 publications

(17 citation statements)

References 30 publications

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“…Since the development of minimally invasive surgical approaches, laparoscopic surgery for gastrointestinal tumors has evolved rapidly over the past decade. Various types of laparoscopic approaches for GISTs have been described, including wedge resection of the stomach, intragastric tumor resection, and combined endoscopic-laparoscopic resection [ 5 - 8 ]. For gastric GISTs, lymph node metastases are rare and localised resection with a clear margin of 1 to 2 cm appears to be an adequate treatment [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up

et al. 2015

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BackgroundThe aim of this study was to compared laparoscopic (LWR) and open wedge resection (OWR) for the treatment of gastric gastrointestinal stromal tumors (GISTs).MethodsThe data of 156 consecutive GISTs patients underwent LWR or OWR between January 2006 and December 2013 were collected retrospectively. The surgical outcomes and the long-term survival rates were compared. Besides, a rapid systematic review and meta-analysis were conducted.ResultsClinicopathological characteristics of the patients were similar between the two groups. The LWR group was associated with less intraoperative blood loss (67.3 vs. 142.7 ml, P < 0.001), earlier postoperative flatus (2.3 vs. 3.2 days, P < 0.001), earlier oral intake (3.2 vs. 4.1 days, P < 0.001) and shorter postoperative hospital stay (6.0 vs. 8.0 days, P = 0.001). The incidence of postoperative complications was lower in LWR group but did not reach statistical significance (4/90, 4.4% vs. 8/66, 12.1%, P = 0.12). No significant difference was observed in 3-year relapse-free survival rate between the two groups (98.6% vs. 96.4%, P > 0.05). The meta-analysis revealed similar results except less overall complications in the LWR group (RR = 0.49, 95% CI, 0.25 to 0.95, P = 0.04). And the recurrence risk was similar in two group (RR = 0.80, 95% CI, 0.28 to 2.27, P > 0.05).ConclusionsLWR is a technically and oncologically safe and feasible approach for gastric GISTs compared with OWR. Moreover, LWR appears to be a preferable choice with mini-invasive benefits.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up

et al. 2015

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“…Various types of laparoscopic approaches for GISTs have been performed in a few specialized centers, including wedge resection of the stomach, intragastric tumor resection, and combined endoscopic-laparoscopic resection [6-9]. Owing to the technique difficulty and relative rarity of GISTs, there is few study of large scale of patients reporting the short- and long-term results for LAP for GISTs compared with open surgery (OPEN).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: an updated systematic review and meta-analysis

et al. 2014

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BackgroundIn past decades, laparoscopic surgery has been introduced for the treatment of gastrointestinal stromal tumors (GISTs). Recently, additional studies comparing laparoscopic versus open surgery for gastric GISTs have been published, and an updated meta-analysis of this subject is necessary.MethodsA systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Comparative studies of laparoscopic and open surgery for gastric GISTs published before June 2014 were identified from databases. The Newcastle-Ottawa Quality Assessment Scale was used to perform quality assessment and original data were extracted. The statistical software STATA (version 12.0) was used for the meta-analysis.ResultsFinally, 22 studies, including a total of 1,166 cases, meet the inclusion criteria for meta-analysis. The operation time was similar between laparoscopic and open surgery. Compared to open surgery, laparoscopic resection was associated withless blood loss (WMD = -58.91 ml; 95% CI, -84.60 to -33.22 ml; P <0.01); earlier time to flatus (WMD = -1.31 d; 95% CI, -1.56 to -1.06, P <0.01) and oral diet (WMD = -1.75 d; 95% CI, -2.12 to -1.39; P <0.01); shorter hospital stay (WMD = -3.68 d; 95% CI, -4.47 to -2.88; P <0.01); and decreased overall complications (relative risk = 0.57; 95% CI, 0.37 to 0.89; P = 0.01). For long-term outcomes, there were no significant differences between two surgical procedures on recurrence.ConclusionLaparoscopic surgery for gastric GISTs is acceptable for selective patients with better short-term outcomes compared with open surgery. The long-term survival situation of patients mainly depends on the nature of tumor itself, and laparoscopic surgery was not associated with worse oncological outcomes.

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“…Such tumors have been reported as the reason for conversion, planned open procedure, and exclusion indication for laparoscopic approach [7] .…”

Section: Discussionmentioning

confidence: 99%

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

Priego¹,

Cuadrado²,

García-Moreno³

et al. 2018

MIS

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Aim: Laparoscopic wedge resection is widely accepted as the choice of treatment for gastric submucosal tumors (GST). However, tumors on the posterior wall at the esophagogastric junction (EGJ) are difficult to approach. Laparoscopic transgastric resection (LTR) is a novel technique to remove gastric tumors that are unresectable by endoscopy due to their size and location. The aim of the article is to assess the feasibility and oncological outcomes of this laparoscopic approach for intraluminal GST located in the posterior wall and near the EGJ. Methods:A retrospective analysis of all patients with GST located at the EGJ who underwent LTR at our institution from January 2015 to February 2016 was performed. Results:Of the 4 patients who underwent LTR, 3 were female and 1 was male, with a mean age of 74.5 years. LTR was successfully performed in all the cases. All patients received a complete resection with negative margins. Histopathologic diagnoses were gastrointestinal stromal tumor in 2 cases and leiomyoma in the other 2. Median tumor size was 3.45 cm. The mean operation time was 173 min (range 120-232 min). One patient experienced a postoperative hematemesis, but was treated conservatively. The mean postoperative stay was 8 days (range 4-15 days). Conclusions:LTR is feasible and difficult localizations can be reached with ease. It is an appropriate alternative to laparoscopic wedge resections especially for localizations that cannot be accessed by laparoscopy such as tumors located near the EGJ.

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Deciding Laparoscopic Approaches for Wedge Resection in Gastric Submucosal Tumors: A Suggestive Flow Chart Using Three Major Determinants

Cited by 25 publications

References 30 publications

Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up

Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up

Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: an updated systematic review and meta-analysis

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

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