Minimally invasive treatment of laparoscopic and endoscopic cooperative surgery for patients with gastric gastrointestinal stromal tumors

Abstract

Objective To evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery (LECS) for the treatment of gastric gastrointestinal stromal tumors (GISTs). Methods We retrospectively reviewed the data of 69 consecutive patients who underwent LECS, including laparoscopy‐assisted endoscopic resection (LAER) and endoscopy‐assisted laparoscopic wedge resection (EAWR), for pathologically confirmed gastric GISTs of less than 5 cm in diameter from January 2006 to October 2012. Results The tumor was located at the upper third of the stomach in 22 patients, the middle third in 38 and the lower third in nine, with a mean tumor size of 2.8 ± 1.6 cm. The operating time was 81.6 ± 31.8 min in the LAER group and 86.3 ± 28.5 min in the EAWR group (P = 0.776). Intraoperative blood loss was 29.8 ± 15.4 mL in the LAER group and 31.4 ± 11.6 mL in the EAWR group (P = 0.561). Most patients had a very low or low risk of tumor recurrence, while six had an intermediate risk of tumor recurrence. The mean length of postoperative hospital stay was 4.6 days. Only two patients had postoperative complications after LECS, both of whom were treated successfully without open surgery. During a median follow‐up of 35 months, all patients were disease‐free, with no tumor recurrence or metastases. Conclusion LECS is a minimally invasive and safe alternative approach which can achieve fast recovery and satisfactory short‐term outcomes for appropriately selected patients with gastric GISTs.

Laparo-endoscopic transgastric resection of gastric submucosal tumors

“…The bleeding was controlled in both cases with endoscopic clips and there were no reoperations. Similar results in terms of postoperative complications were found by Qui et al in 2012 [27]. In our experience, the cause of the bleeding was interpreted as a technical failure in the staple device.…”

“…The principles for the surgical treatment of SMTs have been previously described by different authors and are available in the current guidelines: achievement of negative margins both macroscopically and microscopically, a complete resection of the tumor with low risk of tumor rupture and potential peritoneal seeding, and no lymphadenectomy due to the rare involvement of lymph nodes [27, 28]. On the other hand, it is also affirmed that the survival of patients with these tumors is related with tumor size and histological composition and not associated with microscopic margins of resection, allowing an expanded role for MIS procedures [29].…”

Laparoscopic endoscopic cooperative surgery

“…Tsujimoto et al . and Qiu et al . demonstrated the feasibility and satisfactory outcome of LECS for GIST.…”

Current Status of Exposed Endoscopic Full-Thickness Resection and Further Development of Non-Exposed Endoscopic Full-Thickness Resection

“…In Japan, this technique has been approved of and is covered by health insurance [23,24,25,26,27,28,29,30]. Hand and finger disinfection at the time of surgery serves as a reference for infection control.…”