Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection

Hiki, Naoki; Yamamoto, Yorimasa; Fukunaga, Tetsu; Yamaguchi, Toshiharu; Nunobe, Souya; Tokunaga, Masanori; Miki, Akira; Ohyama, Shigekazu; Seto, Yasuyuki

doi:10.1007/s00464-007-9696-8

Cited by 416 publications

(342 citation statements)

References 17 publications

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“…Hiki et al refer to seven patients all successfully treated with this procedure. The lesions were located close to the esophagogastric junction or in the posterior wall of the stomach, and three of the lesions had a diameter of more than 5 cm, so this technique seems suitable in case of lesions with a difficult location and with larger diameter that are not adequate for the endoscopic treatment [24]. Therefore, ESD could be an acceptable alternative to another modality of treatment for those lesions with concerning EUS features (no extraluminal growth or absence of echopattern consistent with lipoma).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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Background A submucosal tumor (SMT) of the stomach, which is an occasional finding during routine upper gastrointestinal endoscopy, may pose diagnostic and therapeutic challenges. Methods To assess whether endoscopic submucosal dissection (ESD) is a feasible approach to definitively cure SMTs, the authors performed a retrospective cohort study with two endoscopic italian centers.Results The study consisted of 20 patients with SMTs who underwent ESD. The patients underwent ESD and were followed up by endoscopy. We analyzed complete resection rate, frequency of complications, and survival. The overall rate of R0 resection was 90 % (18/20), with two endoscopic failures, one for a submucosal tumor and one for a neoplasm deeply infiltrating the proper muscle layer. The median procedure time was 119.1 min (range 40-240 min). The median size of the resected specimens was 29 mm (range 15-60 mm). Perforation occurred in 3 patients; all were treated conservatively. There were no cases of severe bleeding. Based on histopathological findings, 6 cases of ectopic pancreas, 1 of ectopic spleen, 3 of leiomyoma, and 10 of gastrointestinal stromal tumor (GIST) were diagnosed. Complete resection was obtained in all GIST cases. Among the 10 GIST cases treated by ESD, no death occurred: the 5-year disease-specific survival rate was 100 %. Conclusions The high success rate of 90 % and the low incidence of complications should indicate ESD is the correct diagnostic and definitive treatment in selected patients.

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Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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“…Laparoscopic and endoscopic cooperative surgery (LECS) has been developed as a novel surgical technique for patients with gastric submucosal tumors, such as gastrointestinal stromal tumors 29, 30, 31. As the classical LECS procedure devised by Hiki et al 31.…”

Section: Laparoscopic and Endoscopic Cooperative Surgery Based On Thementioning

confidence: 99%

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

Natsugoe

Arigami

Uenosono

et al. 2017

Annals of Gastroent Surgery

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Recent prospective multicenter trials have demonstrated the clinical safety and efficacy of sentinel node navigation surgery (SNNS) in patients with early gastric cancer. Further, development of an intraoperative imaging system and an indocyanine green fluorescence imaging approach has been attracting attention as a novel tool for detection of the sentinel node (SN). The greatest advantage of an in vivo imaging system is that it visualizes SN and afferent lymphatic vessels from the primary tumor site more clearly than the conventional dye approach. Besides visualization of the SN, it is also essential to accurately assess the presence or absence of lymph node metastasis in the intraoperative management of SNNS. However, the clinical significance of lymph node micrometastasis (LNM) in patients with gastric cancer remains controversial. Reverse transcription‐polymerase chain reaction (RT‐PCR) is one of the representative assays used to identify LNM. A rapid RT‐PCR assay that completes the detection of LNM within approximately 40 minutes has recently been produced and applied in the clinical management of SNNS. From the viewpoint of surgical methods, modified laparoscopic and endoscopic cooperative surgery with non‐exposed approaches has recently been highlighted as a promising technique to prevent tumor dissemination caused by surgical procedures, and is likely to be clinically applied to SNNS in the future. When carrying out SNNS as a minimally invasive surgery, it is important to consider the balance between post‐surgical quality of life and curability. Future prospective studies on SNNS will greatly contribute to furthering its establishment as a beneficial procedure for patients with early gastric cancer.

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“…Furthermore, theoretically, this method enables any lesion located in the stomach to be resected with suitable margins. SMT in the gastric fundus, for example, is difficult to treat by laparoscopic local resection because a linear stapler cannot reach a suitable position, as Hiki et al [6] have mentioned, but the present method would make it possible to treat SMT in the gastric fundus.…”

Section: Discussionmentioning

confidence: 92%

“…Therefore, the indication for EFTR has been limited mainly to submucosal tumors (SMTs) without ulceration. Laparoscopic and endoscopic cooperative surgery (LECS) has also been invented as one of the minimally invasive surgeries mainly for gastric SMTs [6], and has gradually gained acceptance in Japan. LECS is thought to be acceptable because minimal sized local resection is achieved, and a lesion that is technically difficult to resect with a laparoscopic linear stapler can be resected.…”

Section: Introductionmentioning

confidence: 99%

New method of endoscopic full-thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model

et al. 2011

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The indications for endoscopic full-thickness resection (EFTR) are limited because transmural communication during the entire procedure, causing tumor dissemination into the abdominal space, is inevitable. We invented a new method of EFTR without transmural communication, and explored its feasibility in an ex vivo porcine model. Three explanted porcine stomachs were used. First, markings around a model lesion were made with a flexible endoscope, and 0.9% normal saline with indigocarmine was injected into the submucosa around the markings. Second, a circumferential sero-muscular incision was made from the outside with an electrocautery knife, guided by the color of the submucosal injection and intragastric navigation with the endoscope. Third, the muscle layer was linearly sutured with the lesion inverted into the inside. Finally, a circumferential muco-submucosal incision was made with an electrocautery knife employed with the endoscope. The method was performed for 3 lesions (1 anterior wall, 1 lesser curve, and 1 posterior wall of the gastric body), and all lesions were successfully resected in en-bloc fashion. The mean size of the resected specimen was 4.5 cm in diameter. Neither perforation nor apparent air leakage was seen during or after the resection. Non-exposed endoscopic wall-inversion surgery (NEWS) is thought to be effective as a minimally invasive, and minimal-size endoluminal surgery for gastric submucosal tumors with or without ulceration, or even node-negative early gastric cancer that is difficult to resect by endoscopic submucosal dissection.

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Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection

Cited by 416 publications

References 17 publications

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

New method of endoscopic full-thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model

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