Laparoscopic wedge resection of the stomach for gastrointestinal stromal tumor (GIST): non-touch lesion lifting method

Abstract

Background Laparoscopic surgery for GIST carries a risk of intraoperative tumor dissemination. To avoid tumor dissemination, we have utilized a ''non-touch'' method for surgical resection of GIST since 2000. Methods Forty-two patients with gastric GIST were treated at our institution between 2000 and 2012. Laparoscopic wedge resection of the stomach was used as the standard procedure for tumors that were 2-5 cm in size. Tumors larger than 5 cm were treated with open surgery. Our non-touch procedure included a lesion-lifting method using traction sutures at the normal stomach wall around the tumor. Intraoperative gastroscopy was utilized to confirm the location of the tumor with laparoscopy. After lifting of the tumor, tumors with a clear operative margin were resected using a linear stapler. Tumors located at the posterior wall of the stomach or located near the esophagogastric junction were resected using traction sutures. Results Median operative time was 140 min and median blood loss was 0 ml. Postoperative course was uneventful excepting one patient who experienced postoperative bleeding. The median postoperative stay was 7 days. One patient developed liver metastasis after surgery. None of the patients had local recurrence or peritoneal recurrence case. Conclusion This non-touch lesion-lifting method was useful for the surgical management of gastric GIST.

Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study

“…This technique requires one or more gastrotomies. Another series describes a method in which the tumor is removed laparoscopically after traction sutures are placed according to endoscopic guidance to lift the desired area of the stomach [ 20 ]; however, this method could require resection of a large amount of surrounding gastric wall and may not be feasible for tumors near the GE junction or pyloric channel tumors. The hybrid method described here allows a safe, oncologically sound resection of endophytic tumors and tumors in difficult locations while minimizing the proportion of surrounding stomach which is resected.…”

Local resection of the stomach for gastric cancer

“…Non-touch lesion lifting [16] is another method described for laparoscopic local resection of the stomach (Fig. 2).…”

Gastrointestinal Stromal Tumors in the 21<sup>st</sup> Century

“…For GISTs > 5 cm, the use of an endobag may be used to protect the exophytic lesion from lacerations [65]. Specially designed techniques such as a "non-touch lesion-lifting" method have been described in the treatment of GISTs [66].…”

“…This procedure allows for intraoperative definition of the tumor size and additional information required to inform operative decision making [21]. This technique is particularly useful for tumors at the esophagogastric junction [66].…”