Laparoscopic resection for gastrointestinal stromal tumors in the stomach

Kakeji, Yoshihiro; Nakanoko, Tomonori; Yoshida, Rika; Eto, Kojiro; Kumashiro, Ryunosuke; Ikeda, Keisuke; Egashira, Akinori; Saeki, Hiroshi; Oki, Eiji; Morita, Masaru; Ikeda, Tetsuo; Maehara, Yoshihiko

doi:10.1007/s00595-011-0072-x

Cited by 21 publications

(13 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To prevent stenosis after resection by the removal of excessive normal tissue, the direction of the stapler should be perpendicular to the long axis of the stomach, and multiple staplers may be needed. When stenosis is anticipated even with this method, for example, with a 5 cm tumor in the anterior wall of the antrum, the so-called "eversion technique" can be applied 84,85. A gastrotomy is made either proximally or distally with a gross negative margin of normal mucosa about half the length of the circumference of the tumor.…”

Section: Laparoscopic Surgical Technique Based On Tumor Locationmentioning

confidence: 99%

“…After cutting the gastric wall using either energy-based devices or electrocautery, the defect in the gastric wall is approximated together with the stay sutures and hanged up, or a defect and normal mucosa attached to the tumor are lifted up together in an eversion technique. Finally, a linear stapler completes the resection while the endoscopy is kept in the GE junction to prevent stenosis 84,91,92…”

Section: Laparoscopic Surgical Technique Based On Tumor Locationmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

Suh

Yang

2013

J Gastric Cancer

View full text Add to dashboard Cite

Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.

show abstract

Section: Laparoscopic Surgical Technique Based On Tumor Locationmentioning

confidence: 99%

Section: Laparoscopic Surgical Technique Based On Tumor Locationmentioning

confidence: 99%

Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

Suh

Yang

2013

J Gastric Cancer

View full text Add to dashboard Cite

show abstract

“…The goal of the surgery was tumour removal with tumour-free margins wider than 1 cm, controlled histologically (table 3). Tumours measuring more than 6 cm and being located in the posterior wall of the stomach as well as other technical difficulties limited the possibility of laparoscopic intervention [4]. However, our clinical experience showed that in some cases these tumours can be removed endoscopically, which is why surgeons support the initiative of gastroenterologists to perform such procedures for selected patients.…”

Section: Resultsmentioning

confidence: 99%

“…Tumour-free margins of 1–2 cm were recommended several years ago [16]. Tumours measuring 2–5 cm are recommended to be removed laparoscopically [4,17]. Regional lymphadenectomy is generally not required since GISTs rarely (<5%) metastasize to the lymph nodes [18,19].…”

Section: Discussionmentioning

confidence: 99%

Significance of Interdisciplinary Cooperation in the Treatment of Upper Gastrointestinal Mucosal and Submucosal Lesions: A Single Centre Experience

et al. 2012

View full text Add to dashboard Cite

Background: Endoscopic submucosal dissection (ESD) was initially developed in Japan for the treatment of early gastric cancer. Meanwhile ESD has become the treatment of choice for mucosal and submucosal lesions of the oesophagus and stomach. Method: We retrospectively reviewed our data on ESD performed in the period from 2007 to 2011 for the treatment of 67 mucosal and 8 submucosal lesions. These procedures were applied for 60 patients (mean age 63.8 years; 37 female and 23 male). Results: In 4 patients, we found more than 1 lesion for which ESD was applied as a treatment procedure. In 3 patients, ESD was repeated for lesion recurrence in the same location. The ESD specimens were classified as having tumour-free margins in 64 (95.5%) cases; however, during follow-up we identified 7 (10.4%) patients with recurrent lesions, including 3 cases of recurrent hyperplastic polyps, 1 case of early gastric cancer located in the cardia region of the stomach, and 1 case of recurrent flat tubular adenoma in the antral part of the stomach. We experienced 6 cases (8.9%) of delayed post-procedural bleeding all of which were successfully controlled endoscopically. In 5 cases (7.5%), perforation complications occurred. Conclusion: Our first experience with ESD was not all smooth: while the complication rate did not exceed 10%, it was markedly higher than that stated in Eastern literature. We would like to put this down to the learning curve phenomenon. The close cooperation between gastroenterologists and abdominal surgeons was very important and will play a vital role for technological innovations and safety in abdominal medicine in the future.

show abstract

“…and Sakamoto et al . reported LWR techniques for gastric submucosal tumor (SMT) . These techniques are the basis of LWR for gastric GIST, but they were originally employed for whole‐layer dissection of the stomach wall.…”

Section: Discussionmentioning

confidence: 99%