Laparoscopic and Endoscopic Cooperative Dissection for Small Gastric Gastrointestinal Stromal Tumor without Causing Injury to the Mucosa

Abstract

Objective. To investigate the feasibility of laparoscopic and endoscopic cooperative dissection (LECD) for small gastric gastrointestinal stromal tumors (GISTs) without causing injury to the mucosa, compared with ESD surgery which is widely used now. Methods. A total of 25 patients with small gastric GISTs who underwent LECD and 20 patients with small gastric GISTs who underwent ESD between October 2014 and June 2016 were included in this study. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. Patients' clinical data were retrospectively analyzed. Results. In LECD group, the operation was successfully performed in all patients. However, in the ESD group, three patients were transferred to laparoscopic surgery due to intraoperative massive bleeding or intraoperative perforation. No additional targeted chemotherapy drugs for interstitial tumors were prescribed in two groups. There was no difference in the complete tumor capsule rate (100% vs. 90%, p = 0:11), operation time (80:76 ± 13:86 ml vs. 84:05 ± 15:33 ml, p = 0:45), major intraoperative bleeding (0 vs. 5%, p = 0:26), postoperative bleeding (0 vs. 10%, p = 0:11), and postoperative infection (0 vs. 10%, p = 0:11) between the two groups. Compared to ESD (endoscopic submucosal dissection), LECS patients had shorter postoperative indwelling gastric tube (1:04 ± 0:98 d vs. 2:85 ± 0:24 d, p < 0:01), earlier postoperative eating (1:96 ± 0:98 d vs. 3:50 ± 1:15 d, p < 0:01), shorter average postoperative hospital stay (3:44 ± 1:00 d vs. 7:85 ± 1:18 d, p < 0:01), smaller perforation rate (0 vs. 25%, p < 0.05), and fewer surgical supplies. No recurrence or metastasis cases were found between the two groups during the follow-up period, and there were no cases of death due to gastric GISTs. Conclusion. LECD is a novel surgery for small gastric gastrointestinal stromal tumors that leads to satisfactory short-term outcomes and meets the idea of minimally invasive surgery and rapid recovery; compared with ESD, LECD surgery has some advantages in clinical practice. However, further follow-up is needed to confirm.

Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review

“…The drawbacks of LECS are considered the approach to only small lesions and the potential risk of gastric tumor cells spilling into the abdomen because during the procedures the gastric wall may be opened [67,68]. Some modifications to LECS were described, like inverted LECS [69], non-exposure technique (CLEAN-NET) [70], endoscopic full-thickness resection [71], and closed-LECS [72,73]. Despite the fact that there are many reports on LECS procedures which affirm the safety and efficacy of the technique, to date there is not clear evidence to perform GGs resection using LECS.…”

Efficacy and Safety of Laparoscopic Endoscopic Cooperative Surgery in Upper Gastrointestinal Lesions: A Systematic Review and Meta-Analysis

“…The main study characteristics are shown in Table 1 [ 14 , 17 , 19 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Most of the studies (23) were from Asia (96%) and 22 studies (92%) were single-center.…”

“…Three studies compared the outcomes of LECS and ESD in gastric lesions [ 30 , 33 , 38 ]. In meta-analysis, R0, procedure time, hospitalization time, and adverse events were not significantly different between the two groups (shown in Fig.…”

“…Eighteen studies provided data on 702 gastric lesions [ 14 , 17 , 19 , 28 , 29 , 30 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 44 , 45 , 47 , 48 ]. R0 resection rate was 100%.…”

“…All lesions were subepithelial (total of 46 lesions). Regarding gastric lesions, 15 studies reported histological evaluation of 847 surgical specimens [ 17 , 19 , 28 , 29 , 30 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 44 , 45 , 48 ]. One lesion (0.1%) was epithelial [ 39 ] and the other 846 lesions (99.9%) were subepithelial.…”