Laparoscopic resection of submucosal tumor on posterior wall of gastric fundus

Abstract

AIM: Laparoscopic resection of tumors on the posterior wall of gastric fundus, especially when they are next to the esophagocardiac junction (ECJ), is both difficult and timeconsuming. Furthermore, it can lead to inadvertent esophagus stenosis and injury to the spleen. In order to overcome these difficulties, laparoscopically extraluminal resection of gastric fundus was designed to manage submucosal tumors located on the posterior wall of gastric fundus and next to ECJ. METHODS:From January 2001 to September 2003, laparoscopically extraluminal resection of gastric fundus was successfully carried out on 15 patients. There were 11 males and 4 females with an average age of 58 years (range, 38 to 78 years). The mean diameter of the tumors was 4.8 cm. The distance of the tumor border from ECJ was about 1.5-2.5 cm. The four-portal operation procedures were as follows: localization of the tumor, dissection of the omentum, mobilization of the gastric fundus and the upper polar of spleen, exposure of ECJ, and resection of the gastric fundus with Endo GIA. RESULTS:The laparoscopic operation time averaged (66.2±10.4) min, the average amount of bleeding was (89.4±21.7) mL. The mean post-operative hospital stay was (5.3±1.1) d. Within 36 h post-operation, 73.3% of all the patients recovered their gastrointestinal function and began to eat something and to walk. In all the operations, no apparent tumor focus was left and no complication or conversion to open surgery occurred. CONCLUSION:Our newly designed procedure, laparoscopically extraluminal resection of the gastric fundus, can avoid contamination of the abdominal cavity, injury to the spleen and esophageal stenosis. The procedure seems to be both safe and effective.Ke ZW, Zheng CZ, Hu MG, Chen DL. Laparoscopic resection of submucosal tumor on posterior wall of gastric fundus. World

Laparoscopic Wedge Resection for Gastric Submucosal Tumors: A Size-Location Matched Case-Control Study

“…Moreover, various laparoscopic approaches for resection of gastric SMTs have been developed, depending on size, location, and transmural characteristics. 6,7,12,13 Despite these advances, no definite laparoscopic treatment guidelines have been established for gastric SMTs. A consensus meeting in 2005 concluded that laparoscopic surgery should be avoided, especially for GISTs larger than 2 cm, due to the risk of rupture.…”

“…5 Although there were some concerns about performing laparoscopic resections for gastric SMTs located near the pylorus or the esophagogastric junction, Song and colleagues 6 suggested that SMTs near the esophagogastric junction can be successfully resected by a tailored approach using LWR. Similarly, Ke and associates 7 reported that laparoscopic resection of a gastric fundus tumor on the posterior wall was safe and effective.…”

Extraluminal laparoscopic wedge resection of gastric submucosal tumors: a retrospective review of 84 cases

“…It has also been reported that submucosal tumors in the gastric fundus or in the upper part of gastric body can be managed via laparoscopic proximal gastrectomy, whereas postoperative reflux esophagitis is common. For most benign gastric submucosal tumors, the range of such an operation is too large and the procedure is too invasive [1,2].…”

“…2). Briefly, the laparoscope was positioned at portal A (laparoscopic portal, 10 mm); B and C were operating portals (10-12 mm), and an endoscopic gastrointestinal 1962-1968 1963 anastomosis (Endo GIA) stapler was inserted into the abdominal cavity through portal B; a five-finger grasping forceps was placed through portal D to retract the liver and expose the gastric tumors [2]. Tumor locations were first determined laparoscopically, for which three methods could be used: naked-eye inspection, instrument exploration, and intraoperative gastroscopy.…”

“…Tumor locations were first determined laparoscopically, for which three methods could be used: naked-eye inspection, instrument exploration, and intraoperative gastroscopy. In addition to identifying the tumor locations, the distances between tumors and the esophago-cardiac junction (ECJ) should be further confirmed before performing laparoscopic resection of submucosal tumor in the upper part of stomach [1,2]. In this study, the distances from the tumor edges to ECJs ranged from 1.1 to 3.0 cm with a mean of 1.6 ± 0.9 cm.…”